介入栓塞术与开颅夹闭术治疗前交通破裂动脉瘤的疗效与安全性比较

Analysis of the clinical effects of interventional embolization and surgical clipping for the treatment of ruptured anterior communicating artery aneurysms

目的比较介入栓塞及开颅夹闭治疗ACoA破裂的疗效。方法将44例ACoA根据动脉瘤解剖特点、临床表现及患者意愿分为治疗组18例和对照组26例,治疗组采用介入栓塞,对照组采用开颅夹闭,比较分析两组疗效。结果介入组成功栓塞17例,再破裂1例,1例因血管迂曲无法栓塞转为开颅夹闭。出院时恢复良好15例,遗有神经功能缺损2例(记忆力减退1例,单侧下肢肌力减退1例)。开颅组成功夹闭27例(1例由介入组转来),术后脑疝2例,神经功能损伤1例(运动性失语),出院时恢复良好18例,遗有神经功能缺损2例(运动性失语1例,精神症状1例),昏迷7例。结论两者均是前交通破裂动脉瘤的有效治疗方法,介入栓塞术后严重并发症较开颅夹闭少,安全性较高。

Objective To compare the complications and clinical effects of interventional embolization and surgical clipping for the treatment of ruptured anterior communicating artery aneurysm（ACoA）.Methods The present study included 44 patients, all of them were admitted to the Affiliated Hospital of Chengde Medical College during the period between January 2014 and December 2015. Of the 44 patients,18 patients were treated with interventional embolization（interventional embolization group）and 26 cases were performed with surgical clipping treatment（surgical clipping group）.The postoperative complications and clinical effects were compared between the two groups. Results Of the 18 patients in the interventional embolization group,17 patients were achieved embolization totally,postoperative rebleeding occurred in 1 patient within 10 days after interventional embolization therapy, and 1 patient was converted to surgical clipping treatment for vascular circuity. At discharge, 15 patients achieved good recovery, and 2 cases had neurological deficits（Memory loss and paralysis of lower limb）. In the surgical clipping group,27 cases were achieved clipping completely,2 patients were diagnosed as hernia of brain and 1 patient experienced neurological decline（aphasia）after surgical clipping treatment. 18 patients recovered well, 2 cases had neurological deficits（aphasia and mental symptoms）and 7 patients were still in a coma at discharge. Conclusion The interventional embolization and the surgical clipping both are effective treatment of ruptured anterior communicating artery aneurysms. The interventional embolization carries lower serious complication incidence.