血管内栓塞和开颅夹闭治疗急性期低级别破裂大脑中动脉瘤效果比较

Treatment for low- grade ruptured middle cerebral artery aneurysms in acute phase: comparison of curative effect between endovascular embolization and craniotomy clipping

目的分析血管内栓塞术和开颅夹闭术治疗对急性期低级别破裂大脑中动脉瘤患者预后的影响。方法回顾性分析2011年1月至2014年6月收治的急性期低级别破裂大脑中动脉瘤患者临床资料。根据治疗方法将患者分成两组，A组动脉瘤破裂后72h内接受血管内栓塞术，B组动脉瘤破裂后72h内接受开颅夹闭术。对两组患者临床特征及影像学特征作单因素分析和Logistic多因素分析。结果共有95例患者符合本研究纳入标准，其中A组52例，B组43例，两组患者人院时临床特征及影像学特征无明显差异。术后6个月临床随访显示A组患者中48例（92．3％）预后良好（mRS评分0—2分），B组患者中38例（88．4％）预后良好，两组间差异无统计学意义（P=0．727）。DSA复查显示A组动脉瘤复发率较B组高，但差异无统计学意义（P=0．373）。多因素Logistic回归分析显示，两种治疗方法对患者预后没有影响（P=0．354，OR2．431，95％a0．371～15．927）。结论血管内栓塞术和开颅夹闭术治疗低级别破裂大脑中动脉瘤均能取得满意效果，临床上应根据患者具体病情选择最合适术式并尽早治疗。

Objective To analyze the effect of endovascular embolization and craniotomy clipping treatment on the prognosis of patients with ruptured middle cerebral artery aneurysms in acute phase. Methods The clinical data of a total of 95 patients with ruptured middle cerebral artery aneurysms in acute phase, who were admitted to authors＇ hospital during the period from January 2011 to June 2014, were retrospectively analyzed. According to the treatment, the patients were classified into group A （n=52） and group B （n=43）. Patients in group A were treated with endovascular embolization performed within 72 hours after the onset of aneurysm rupture, and patients in group B received craniotomy clipping within 72 hours after the onset of aneurysm rupture. Using univariate analysis and multivariate logistic regression analysis, the clinical features and imaging characteristics of the two groups were analyzed. Results A total of 95 patients fulfilled the inclusion criteria, including 52 patients in group A and 42 patients in group B. On admission, no significant differences in clinical features and imaging characteristics existed between the two groups. Follow- up examination at 6 months after treatment showed that good response （mRS=0-2） was obtained in 48 patients （92.3%） of group A and 38 patients （88.4%） of group B, and the difference between the two groups was not statistically significant （P=-0.727）. DSA reexamination revealed that the recurrence rate of aneurysm in group A was higher than that in group B, although the difference between the two groups was not statistically significant （P=0.373）. Multivariate logistic regression analysis indicated that both therapeutic methods had no influence on clinical outcome （P=0.354; 0R=2.431; 95%CI：0.371-15.927）. Conclusion Both endovascular embolization and craniotomy clipping can achieve satisfactory clinical results for ruptured middle cerebral artery aneurysms in acute phase. Clinically, based on the patient＇s specific condition the most appropriate therapy should be carried out as early as possible.