血管内介入治疗颅内破裂动脉瘤的疗效分析

Curative effect of endovascular treatment for ruptured intracranial aneurysms

目的通过与显微手术夹闭方案对比,明确血管内介入治疗颅内破裂动脉瘤的临床疗效与适应性。方法对2013年1月至2016年1月我院收治的102例颅内破裂动脉瘤患者进行回顾性分析及持续随访。将接受显微手术夹闭的61例患者作为对照组,接受血管内介入治疗的41例患者作为观察组。对比两组患者平均住院时间、动脉瘤完全闭塞率、术中及术后并发症、出院时及出院6个月时格拉斯哥预后评分(GOS)、复发率、死亡率。结果观察组住院时间(13.5±2.8)d,明显短于对照组的(23.7±3.8)d;观察组术后即刻复查,动脉瘤完全闭塞率90.0%,明显低于对照组的100.0%;观察组复发率19.5%,明显高于对照组的1.6%,上述差异均有统计学意义(P<0.05)。两组出院时及出院6个月时GOS评分、死亡率、术中及术后并发症发生情况比较,差异均无统计学意义(P>0.05)。结论血管内介入治疗颅内破裂动脉瘤能够获得与显微手术夹闭方案相近的近期临床疗效,且患者术后恢复较快,安全性高,对显微手术难以夹闭的区域也有一定的适应性,但可能增加复发率。

Objective To investigate the clinical efficacy and adaptability of endovascular interventional treatment for intracranial ruptured aneurysms by comparing with the microsurgical clipping. Methods One hundred and two cases of ruptured intracranial aneurysms in our hospital from January 2013 to January 2016 were retrospectively analyzed and continuously followed up. Sixty-one patients who were treated with microsurgica[ clipping were included as the control group, while forty-one patients who were treated with endovascular intervention were included as the observation group. The average time of hospital stay, the effect of aneurysms occlusion, intraoperative and postoperative complications, GOS score at the time of discharge and six months after discharge, recurrence rate and mortality rate were compared between the two groups. Results The average time of hospital stay in the observation group was （13.5±2.8） d, which was significantly shorter than （23.7±3.8） d in the control group. The total occlusion rate of aneurysms immediately after surgery in the observation group was 90.0%, which was significantly less than 100.0% in the control group. The recurrence rate in the observation group was 19.5 %, which was significantly more than 1.6% in the control group. The differences above were statistically significant （P%0.05）. There was no significant difference in GOS score at discharge and six months after discharge, mortality, intraoperative and postoperative complications between the two groups （P^0.05）. Conclusion The short-term clinical results of endovaseular interventional treatment of intracrania[ ruptured aneurysm is close to microsurgical clipping. Endovascular interventional has fast and safe postoperative recovery, especially for the aneurysms difficult to clamp, but it may increase the rate of recurrence in patients.