血管内栓塞治疗颅内动脉瘤的中长期临床随访研究

The mid-long term follow-up of endovascular embolization treatment of intracranial aneurysms

目的 观察血管内栓塞治疗颅内动脉瘤的中长期临床随访结果,探讨影响动脉瘤复发的相关因素.方法 回顾性纳入复旦大学附属华山医院放射科2006年6月至2015年8月采用血管内栓塞治疗、术后行数字减影血管造影（DSA）随访时间超过18个月的颅内动脉瘤患者,共69例患者80个动脉瘤.观察患者的预后及影响动脉瘤复发的相关因素.结果 随访时间为18 ～ 133个月,平均（39.0＆#177;22.6）个月.69例患者中,预后良好率（改良Rankin量表评分＜2分）为94.2％（65/69）,无死亡病例.80个动脉瘤中,21个复发,复发率为（26.3％）.单因素分析结果显示,巨大动脉瘤复发比例最高（5/6）,小动脉瘤复发率最低（16.7％,9/54）,大动脉瘤复发率为35.0％ （7/20）,差异有统计学意义（P=0.002）.不完全栓塞者动脉瘤复发比例高于完全栓塞者,分别为58.8％ （10/17）、17.5％ （11/63）,差异有统计学意义（P=0.001）;宽颈动脉瘤复发率高于窄颈动脉瘤[分别为36.2％（17/47）、12.1％ （4/33）],差异有统计学意义（P=0.032）.而动脉瘤部位及治疗方法对动脉瘤复发的影响差异无统计学意义.多因素Logistic回归分析显示,动脉瘤大小是动脉瘤复发的独立危险因素（OR=3.828,95％ CI：1.674～8.754,P＜0.001）.结论 血管内栓塞治疗颅内动脉瘤总体疗效较好.动脉瘤大小是影响动脉瘤复发的独立危险因素,动脉瘤瘤颈及术后栓塞程度可能影响动脉瘤的复发.

Objective To observe the mid-long term follow-up results of endovascular embolization treatment of intracranial aneurysms and to investigate the factors related to post-operative recurrence.Methods A total of 69 patients （80 aneurysms） were angiographically followed up by DSA over 18 months who were admitted to Department of Interventional Radiology,Huashan Hospital Affiliated to Fudan University,between June 2006 and August 2015 and enrolled in this retrospective study.All those patients underwent endovascular embolization treatment and studied for clinical prognosis and related factors of the recurrence.Results The follow-up period lasted 18-133 months with an average of 39.0 ± 22.6 months.Out of 69 patients,65 （94.2%） reported good outcomes with modified Rankin scale score 〈 2.There was no death in this series.Out of 80 aneurysms,21 （26.3%） had recurrence.Univariate analysis demonstrated that the recurrence rate was the highest （83.3%,5/6） in the giant aneurysm group,the lowest （16.7%,9/54）in the small aneurysm group,and 35.0% （7/20） in the large aneurysm group.The difference was statistically significant （P =0.002）.Incomplete embolization group had higher recurrence rate than complete embolization group [58.8% （10/17） vs.17.5% （11/63）,P =0.001].Recurrence rate of wide-necked aneurysms was higher than narrow-necked ones [36.2% （17/47） vs.12.1% （d/33）,P =0.032].However,the location and treatment approach of aneurysms seemed to have little effect on the recurrence.Multivariate regression analysis suggested that the aneurysm size was the independent risk factor of recurrence （OR =3.828,95% CI：1.674-8.754,P 〈 0.001）.Conclusions The overall clinical effects of endovascular embolization treatment on intracranial aneurysms seem to be satisfactory.The aneurysm size was the independent risk factor of recurrence.The shape of aneurysm neck and extent of embolization may affect the recurrence of aneurysm.