前交通动脉瘤730例患者治疗的预后情况及其危险因素分析

Analysis of prognosis and risk factors of 730 patients with anterior communicating aneurysm

目的:探究前交通动脉瘤患者通过动脉瘤夹闭术或介入栓塞治疗的预后情况及其危险因素。方法:回顾性分析苏州大学附属第一医院神经外科1999年1月至2018年12月通过动脉瘤夹闭术和介入栓塞治疗的730例前交通动脉瘤患者的临床资料。分别比较1999—2008年夹闭组与2009—2018年夹闭组、2009—2018年夹闭组与2009—2018年介入组患者的预后情况,并对影响患者预后的危险因素进行统计学分析。结果:1999—2008年夹闭组患者的预后不良率为32.7%,2009—2018年夹闭组患者的预后不良率降低为21.3%,且2009—2018年夹闭组术中动脉瘤破裂、术后脑梗死率均较低(P<0.05)。2009—2018年夹闭组与介入组患者的预后差异无统计学意义(P>0.05)。多因素分析结果为术前Hunt-Hess分级、术后脑梗死及脑出血在不同预后组间差异有统计学意义(P<0.05)。结论:2009—2018年夹闭组患者的预后比1999—2008年夹闭组有明显改善;2009—2018年夹闭组与介入组患者的预后差异无统计学意义;术前Hunt-Hess分级、术后脑梗死、术后脑出血是影响预后的危险因素。

Objective To investigate the prognosis and risk factors of patients with anterior communicating aneurysm treated by aneurysm clipping or interventional embolization.Methods The clinical data of 730 patients with anterior communicating aneurysm who underwent aneurysm clipping or interventional embolization in the department of neurosurgery,the first affiliated hospital of Soochow University from January 1999 to December 2018 were retrospectively analyzed.The prognosis of patients in the clipping group from 1999 to 2008 and the clipping group from 2009 to 2018,the clipping group from 2009 to 2018 and the interventional group from 2009 to 2018 were compared respectively,and the risk factors affecting the prognosis of patients were statistically analyzed.Results The rate of poor prognosis was 32.7%in the clipping group from 1999 to 2008,21.3%in the clipping group from 2009 to 2018,and the rate of intraoperative aneurysm rupture and postoperative cerebral infarction was lower in the clipping group from 2009 to 2018(P<0.05).There was no significant statistical difference in the prognosis between the clipping group and the interventional group from 2009 to 2018(P>0.05).The results of multivariate analysis showed that preoperative Hunt-Hess grade,postoperative cerebral infarction and postoperative hemorrhage were the risk factors affecting the prognosis of patients(P<0.05).Conclusion The prognosis of patients treated by clipping from 2009 to 2018 was significantly improved compared with that from 1999 to 2008.There was no significant difference in the prognosis between the clipping group and the interventional group from 2009 to 2018.Preoperative Hunt-Hess grading,postoperative cerebral infarction and postoperative hemorrhage were independent risk factors affecting the prognosis.