显微手术夹闭及血管内介入栓塞术治疗高分级大脑中动脉瘤破裂的疗效及安全性研究

Efficacy and Safety of Microsurgical Clipping and Intravascular Interventional Embolization in the Treatment of Poor-grade Middle Cerebral Artery Aneurysm Rupture

目的探讨显微手术夹闭及血管内介入栓塞术治疗高分级大脑中动脉瘤(MCAA)破裂的近期效果及安全性。方法选取2011年4月—2014年3月承德医学院附属医院神经外科收治的高分级MCAA破裂患者107例,按照手术方式分为两组,夹闭组52例:采用显微手术夹闭治疗;介入组55例:采用血管内介入栓塞术治疗。术前、术后3个月应用Fisher分级及术后3个月时应用Barthel指数(BI)对预后进行测评,并观察并发症发生情况。结果术前及术后3个月夹闭组与介入组患者Fisher分级比较,差异均无统计学意义(P>0.05)。夹闭组和介入组患者术前与术后3个月Fisher分级比较,差异均有统计学意义(u=4.687、5.455,P<0.05)。术后3个月时,夹闭组患者BI评分为(46.1±9.5)分,介入组为(48.2±8.4)分,差异无统计学意义(P>0.05)。夹闭组患者并发症发生率为19.2%(10/52),介入组为23.6%(13/55),差异无统计学意义(P>0.05)。夹闭组与介入组患者脑血管痉挛、脑梗死、脑积水、再破裂发生率比较,差异均无统计学意义(P>0.05)。结论显微手术夹闭与血管内介入栓塞术对高分级MCAA破裂的治疗效果确切,两种方法治疗后Fisher分级、BI评分、并发症发生率均无差异。

Objective To investigate the short- term efficacy and safety of microsurgical clipping and intravascular interventional embolization in the treatment of poor- grade middle cerebral artery aneurysm（ MCAA） rupture. Methods Enrolled 107 patients with poor grade MCAA rupture who were admitted into the Department of Neurosurgery of the Affiliated Hospital of Chengde Medical University from April 2011 to March 2014. According to surgical methods,we assigned 52 patients into clipping group in which microsurgical clipping was undertaken and assigned 55 patients into intervention group in which intravascular interventional embolization was undertaken. Before and after three months surgeries, Fisher grading and Barthel index（ BI） were used to evaluate the prognosis,and the occurrence of complications was observed. Results Before and three months after operation,the two groups were not significantly different in Fisher grading（ P〉0. 05）. The patients of clipping group and intervention group were significantly different in Fisher grading between before and three months after operation（ u= 4. 687,5. 455,P〉0. 05）. Three months after operation,the BI score was（ 46. 1 ± 9. 5） for clipping group and was（ 48. 2± 8. 4） for intervention group,with no significant difference between them（ P〈0. 05）. The incidence of complications was19. 2%（ 10 /52） in clipping group and was 23. 6%（ 13 /55） in intervention group,with no significant difference between the two groups（ P〉0. 05）. The two groups were not significantly different in the incidence rates of cerebral angiospasm,cerebral infarction,hydrocephalus,and the incidence of the recurrence of rupture（ P〈0. 05）. Conclusion Microsurgical clipping and intravascular interventional embolization have obvious efficacy in the treatment of poor- grade MCAA. The two therapies are not significantly different in Fisher grading,the incidence of complication and BI score.