后交通动脉瘤介入栓塞术与外科夹闭术疗效分析

Analysis of the therapeutic effect of interventional embolization and surgical clipping for the treatment of posterior communicating artery aneurysms

目的对比分析介入栓塞术与外科夹闭术治疗后交通动脉瘤的并发症及预后。方法2013年8月至2015年3月在郑州大学第二附属医院确诊的后交通动脉瘤患者90例,其中接受介入栓塞术治疗患者49例（介入栓塞组）,接受外科夹闭术治疗患者41例（外科夹闭组）。术前根据Hunt-Hess分级对患者进行评估,术后根据Glasgow预后量表（GOS）评分进行评估,比较两组不同Hunt-Hess分级患者术后GOS评分和并发症发生情况。结果介入栓塞组Hunt-Hess 0-Ⅲ级患者术后GOS评分与外科夹闭组0-Ⅲ级患者比较,差异无统计学意义（t=0.842,P〉0.05）;介入栓塞组Hunt-HessⅣ级患者GOS评分高于外科夹闭组Ⅳ级患者,差异有统计学意义（t=1.713,P〈0.05）。介入栓塞组并发症发生率低于外科夹闭组,差异有统计学意义（χ^2=1.036,P〈0.05）。结论介入栓塞术与外科夹闭术相比,治疗0-Ⅲ级后交通动脉瘤的临床预后效果无差异,治疗Ⅳ级患者的临床预后效果优于外科夹闭术,手术风险及并发症发生情况均低于外科夹闭术,疗效更为可靠。

Objective To analyze the complications and clinical effects of interventional embolization and surgical clipping for the treatment of posterior communicating artery aneurysms, and to compare the results between the two methods. Methods A total of 90 patients with confirmed posterior communicating artery aneurysm, who were admitted to the Second Affiliated Hospital of Zhengzhou University during the period from August 2013 to March 2015, were enrolled in this study. Of the 90 patients, 49 received interventional embolization therapy（interventional embolization group） and 41 underwent surgical clipping treatment（surgical clipping group）. Before the treatment the patient＇s condition was evaluated according to Hunt- Hess classification, after the treatment the therapeutic effect was assessed with Glasgow prognosis scale（GOS）. The postoperative GOS scores and complications in patients with different Hunt- Hess classification were compared between the two groups. Results In patients of Hunt- Hess 0- Ⅲ grade, no statistically significant differences in postoperative GOS scores existed between the interventional embolization group and the surgical clipping group（t=0.842,P〉0.05）, while the postoperative GOS scores in patients of Hunt- HessⅣ grade of the interventional embolization group was remarkably higher than that in patients of Hunt-Hess Ⅳgrade of the surgical clipping group, the difference was statistically significant（t =1.713,P 0.05）. The incidence of complications in the interventional embolization group was significantly lower than that in the surgical clipping group（χ^2=1.036,P〈0.05）. Conclusion For the treatment of Hunt- Hess 0- Ⅲgrade posterior communicating artery aneurysms, the interventional embolization and the surgical clipping show no difference in their therapeutic effects; while for the treatment of Hunt- Hess Ⅳ grade posterior communicating artery aneurysms, the interventional embolization in superior to the surgical clipping, as the interventional embolization carries lower operation risk and complication incidence, and it also has reliable effect.