电解可脱卸弹簧圈栓塞治疗颅内破裂动脉瘤的临床效果及影响因素分析

The clinical effect and influencing factors analysis of guglielmi detachable coil embolization for the treatment of intracranial aneurysm rupture

目的:探讨电解可脱卸弹簧圈栓塞治疗颅内破裂动脉瘤的临床效果,以及对该术的影响因素。方法:选择2013年7月至2O17年7月收治的150例行电解可脱卸弹簧圈栓塞治疗的颅内破裂动脉瘤患者(163个动脉瘤)作为研究对象,其中11例为非单一性动脉瘤患者。对动脉瘤的大小、部位、行栓塞治疗时机、栓塞程度以及对手术前后Hunt-Hess分级、GCS评分、并发症等方面进行分析。结果:150例患者全部手术成功,早期手术(≤72 h) 123例,中期手术(4~10 d) 19例,晚期手术(> 10 d) 8例。Hunt-Hess分级中,预后良好(GOS> 3分)者Ⅰ~Ⅱ级患者为100%,Ⅲ级患者为83. 3%,Ⅳ~Ⅴ级患者为54. 5%;完全栓塞(100%)的为134例,部分栓塞(> 90%)的为11例,小部分栓塞(≤90%)的为5例。GCS评分术前与首次蛛网膜下腔出血后1个月比较,差异有统计学意义(P <0. 05),与动脉瘤的大小、部位则无明显的关系(P> 0. 05)。结论:电解可脱卸弹簧圈治疗颅内破裂动脉瘤的临床效果显著,临床疗效与手术时机、动脉瘤的栓塞程度、Hunt-Hess分级、GCS评分均相关。

Objective： To analyse the clinical effect of the guglielmi detachable coil for the treatment of the ruptured intracranial aneurysms and the factors affecting the operation. Methods： A total of 150 patients（ 163 aneurysms） with intracranial ruptured aneurysm were treated with guglielmi detachable coil embolization,who were enrolled from July 2013 to July 2017. The size of aneurysm,location,timing of embolization,degree of embolism,Hunt-Hess grade,GCS score and the postoperative complications were analysed. Results： 150 patients were successfully operated. There were 123 cases of early surgery（ ≤72 h）,19 cases of mid-term surgery（ 4-10 d）and 8 cases of late surgery（〉10 d）. In the Hunt-Hess classification,100% of grade Ⅰ-Ⅱ patients,83. 3% of grade Ⅲ patients and 54. 5% of grade Ⅳ-Ⅴ patients had a good prognosis（ GOS〉3）. 134 patients were completely embolized（ 100%）,partial embolization（〉90%） in 11 cases,small partial embolization（ ≤90%）in 5 cases. The difference of GCS score between preoperation and one month after the first subarachnoid hemorrhage had statistical significance（ P〈0. 05）. Conclusion： The guglielmi detachable coil is effective in treating intracranial ruptured aneurysms,and the effect is related to the timing of operation,the degree of aneurysm embolization at surgery,the Hunt-Hess grade and GCS score.