显微及介入手术在颈内动脉-后交通动脉瘤中的疗效比较

The comparison of therapeutic effects of microsurgery and interventional surgery in PcoA

目的分析开颅显微手术和血管内介入栓塞术在颈内动脉-后交通动脉瘤（Internal carotid artery posterior communicating artery aneurysm,PcoA）患者治疗中的预后情况及其临床意义。方法分析2012年4月至2015年1月在我院接受治疗的108例PcoA患者的临床资料。根据手术方式的不同,将入选者分成显微术组（48例）和介入组（60例）两组。比较两组患者的一般资料、Rankin评分、Rankin评分与预后的关系以及并发症发生情况。结果两组患者的一般资料无统计学差异（P〉0.05）。两组患者的Rankin评分差异显著（P〈0.05）,其中显微组患者的致死率（4.2%）、致残率（12.5%）比介入组（1.7%,3.3%）高。在年龄≥60岁、发病时间〉14d、Hunt-Hess分级≥III级时,介入组患者的Rankin评分水平均显著低于显微组患者（P〈0.01）。显微组患者术后并发症发生率明显低于介入组（P〈0.05）,其中显微组的动脉瘤复发率（2.1%）低于介入组（8.3%）,瘤颈残留率（6.3%）低于介入组（13.3%）,两组再出血率无显著差异。结论与开颅显微手术相比,PcoA患者采用血管内介入栓塞术治疗的优势更加突出,且应尽量在早期（0~3d）实施手术。

Objective Our retrospective study was aimed toanalyze the prognosis and clinical significance of craniotomy microsurgery and intravascular interventional embolization in treating patients with PcoA.Methods Clinical data of 108 patients with PcoAreceived treatment at our hospitalfrom April,2012 to January,2015 was retrospectivelyanalyzed.Patients included were divided into two groups according to the treatment,microsurgery group（craniotomy microsurgery,48cases）and interventional group（intravascular interventional embolization）.The general information,Rankin scores,the relationship between Rankin scores and prognosis,the complications between two groups were compared.Results The general information between two groups had no statistical difference（P0.05）.The Rankin scores between two groups had statistical difference（P0.05）.The case fatality rate（4.2%）,disability rate（12.5%）of patients in microsurgery group（1.7%,3.3%）were higher than those in interventional group.When the age≥60years old,onset time14d,Hunt-Hess stages≥III,the Rankin scores of patients in interventional group were all obviously lower than those in microsurgery group（P0.01）.The occurrence of complications of patients in microsurgery group was obviously lower than that in interventional group（P0.05）.The rate of aneurysm recurrence of patients in microsurgery group（2.1%）was lower than that in interventional group（8.3%）.The rate of residual tumor neck of patients in microsurgery group（6.3%）was lower than that in interventional group（13.3%）.The differences in the rate of rehaemorrhagia of patients in two groups were not obvious.Conclusion Comparing to the craniotomy microsurgery,intravascular interventional embolization has obvious superiority in treating patients with PcoA,and surgery should be carried out in early（0-3d）.