动脉瘤介入栓塞术与颅内动脉瘤夹闭术治疗高分级动脉瘤性蛛网膜下腔出血的效果比较

The clinical efficacy of interventional embolization of aneurysm and clipping of intracranial aneurysm in the tratment of high grade aneurysmal subarachnoid hemorrhage

目的比较并分析动脉瘤介入栓塞术与颅内动脉瘤夹闭术治疗高分级动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)的临床效果及安全性。方法随机选取2010年10月至2016年10月本院收治的100例世界神经外科学会联合会(World Federation of Neurosurgical Societies,WFNS)分级为Ⅳ~Ⅴ级(高分级)的aSAH患者为研究对象。根据手术方式将入选患者分为栓塞组和夹闭组,每组各50例。栓塞组患者行弹簧圈瘤腔内栓塞和支架辅助栓塞,夹闭组患者行开颅动脉瘤夹闭术。采用格拉斯哥结局量表(Glasgow outcome scale,GOS)评价患者治疗3个月后的临床效果,记录脑积水、再出血及脑血管痉挛的发生情况。采用免疫比浊法检测并比较术前和术后第3天两组患者血清免疫球蛋白(immunoglobulin,Ig)G、IgA及IgM水平。结果栓塞组患者预后良好率显著高于夹闭组(P<0.05),并发症发生率显著低于夹闭组(P<0.05)。术后第3天,两组患者IgG、IgA及IgM水平较术前均显著下降(P<0.05),且夹闭组患者IgG、IgA及IgM水平均显著低于栓塞组(P<0.05)。结论与颅内动脉瘤夹闭术相比,动脉瘤介入栓塞术治疗aSAH效果更佳,并发症发生率更少,且对患者免疫功能影响较小。

Objective To compare and analyze the clinical efficacy and safety of interventional emboliz？ation of aneurysm clipping of intracranial aneurysms in the treatment of high grade aneurysmal subarachnoid hemorrhage （aSAH）. Method 100 cases with World Federation of Neurosurgical Societies （WFNS） grade atⅣ～Ⅴ grade （high grade） enrolled in our hospital from October 2010 to October 2016 were randomly selected as the research objects. Patients were divided into embolization group and clipping group according to the operation methods, 50 cases in each group. Embolization group patients received endovascular embolization and stent embolization, and clipping group patients received clipping of aneurysm. The clinical outcomes of patients were evaluated with Glasgow outcome scale （GOS） 3 months after operation. The occurrence of hydrocephalus, rebleeding and cerebral vasospasm were recorded. Serum levels of immunoglobulin （Ig） G, IgA and IgM were detected by immunoassay in the two groups before and 3 days after operation. Result The favorable prognosis rate of the embolization group was significantly higher than that of clipping group （P〈0.05）, and the complication rate was significantly lower than that of clipping group （P〈0.05）. 3 days after operation, the levels of IgG, IgA and IgM in the two groups were significantly lower than those before operation （P〈0.05）, and the levels of IgG, IgA and IgM in clipping group were significantly lower than those in embolization group （P〈0.05）. Conclusion Compared with clipping of intracranial aneurysm, interventional embolization of intracranial aneurysm is more effective for the treatment of aSAH, with less complication, and has less influence on the immune function.