开颅手术与血管内栓塞对颅内后循环动脉瘤患者的疗效及颅脑损伤因子的影响

Curative effect of craniotomy and endovascular embolization on patients with intracranial aneurysms of the posterior cerebral circulation and the effect on craniocerebral injury factor

目的探讨开颅手术与血管内栓塞对颅内后循环动脉瘤患者的疗效及颅脑损伤因子的影响。方法选取我院收治的颅内后循环动脉瘤患者78例,按治疗方式不同将所有患者分为对照组(n=39)和观察组(n=39)。对照组采用开颅手术治疗,观察组采用血管内栓塞治疗,两组术后均随访6个月。采用哥斯拉哥预后评分(GOS)评估两组术后6个月疗效,比较两组术前、术后24h血清神经元特异性烯醇化酶(NSE)、S-100β、基质金属蛋白酶-9(MMP-9)水平,比较两组术前,手术结束时,术后12、24h全血CD3^+、CD4^+、CD8^+等细胞免疫指标,比较两组术后并发症发生情况。结果观察组良好率为92.31%,较对照组的58.97%显著升高(P<0.05);与术前比较,术后24h对照组患者血清NSE水平显著升高(P<0.05),血清S-100β、MMP-9水平无显著变化(P>0.05),术后24h观察组患者血清NSE、S-100β、MMP-9水平显著降低,且均显著低于对照组(P<0.05);与手术结束时比,术后12、24h两组全血CD3+、CD4+水平及术后24h观察组全血CD8+水平显著升高,且观察组均显著高于对照组(P<0.05),术后24h两组及术后12h观察组CD4+/CD8+显著降低,且观察组显著低于对照组(P<0.05),术后12h对照组全血CD8+水平及CD4+/CD8+无显著变化(P>0.05);观察组术后并发症发生率为7.69%,较对照组的30.77%显著降低(P<0.05)。结论血管内栓塞治疗颅内后循环动脉瘤疗效显著,可降低颅脑损伤程度,对患者细胞免疫功能影响较小,且术后并发症发生率显著低于开颅手术治疗,有利于患者术后恢复。

Objective To explore the curative effect of craniotomy and endovascular embolization on patients with intracranial aneurysms of the posterior cerebral circulation and the effect on craniocerebral injury factor. Methods 78 patients with intracranial aneurysms of the posterior cerebral circulation who were admitted and treated in our hospital were selected. According to different treatment methods, they were divided into the control group (n=39) and observation group (n=39). The control group was treated with craniotomy while the observation group was treated with endovascular embolization. Patients in the two groups were given follow-ups for 6 months after surgery. The curative effect of 6 months after operation in two groups was evaluated by Godzilla outcome scale (GOS). The serum neuron-specific enolase (NSE), S-100β and matrix metalloproteinase-9 (MMP-9) levels of 24 hours before and after operation in two groups were compared. The whole blood CD3+, CD4+, CD8+ and other cellular immune indicators before operation, at the end of operation and 12 and 24 hours after operation in two groups were compared. The occurrence of postoperative complications in two groups was compared. Results The good rate of the observation group was 92.31%, significantly higher than that of the control group 58.97%(P < 0.05). Compared with that before operation, the serum NSE level of 24h after operation in control group was significantly increased (P < 0.05). There was no significant change in serum S-100β and MMP-9 levels after operation compared with those before operation (P > 0.05). The serum NSE, S-100β and MMP-9 levels of 24 h after surgery in observation group were significantly decreased, and all of which were significantly lower than those in control group (P < 0.05). Compared with those at the end of surgery, the whole blood CD3+ and CD4+ levels of 12 and 24 h after surgery in two groups and CD8+ levels of 24h after surgery in the observation group were all significantly increased, and those in the observation group were significantly higher than those in control group (P < 0.05).The whole blood CD4+/CD8+ of 24 h after surgery in two groups and of 12 h after surgery in the observation group were all significantly decreased, and that in the observation group was significantly lower than that in the control group (P < 0.05). There was no significant difference in whole blood CD8+ and CD4+/CD8+ of 12h after surgery in the control group (P > 0.05). The incidence of postoperative complications in observation group was 7.69%, which was significantly lower than that in control group 30.77%(P < 0.05). Conclusion Endovascular embolization in treatment of patients with intracranial aneurysms of the posterior cerebral circulation has a significant curative effect, which can reduce the degree of craniocerebral injury. It has a small effect on the patient’s cellular immune function and the incidence of postoperative complications is significantly lower than that of craniotomy, which is conducive to the patient’s postoperative recovery.