双容积重建在颅内动脉瘤介入栓塞中的价值分析

Dual volume reconstruction technique in interventional embolization of intracranial aneurysms:analysis of its clinical application value

目的探讨双容积重建(DVRT)技术对颅内动脉瘤介入栓塞程度评价的作用及其对术后并发症的影响。方法选取2018年6月至2019年10月单中心介入栓塞术治疗的112例颅内动脉瘤患者(127枚动脉瘤)。随机分为常规评估组和DVRT评估组,每组56例。常规评估组在术前血管造影和麻醉后3D重建基础上选择最佳工作角度行动脉瘤介入栓塞,2D-DSA评估为致密栓塞后完成手术;DVRT评估组在2D-DSA评估致密栓塞后行3D采集和DVRT,评估为非致密栓塞继续介入干预,评估为致密栓塞完成手术。对比两组术中对比剂用量、X线剂量,术后出血复发率及手术费用等情况。结果DVRT评估组未出现出血复发,常规评估组出血复发率为5.36%(3/56)(P<0.05)。两组患者术中对比剂用量、X线剂量及手术费用差异无统计学意义(P>0.05)。术后3个月全脑血管DSA复查显示,DVRT评估组、常规评估组血栓形成分别为1例(1.8%)、7例(12.5%),动脉瘤复发分别为0例、6例(10.7%),脑梗死分别为0例、5例(8.9%),差异均有统计学意义(χ^(2)=4.846、6.340、5.234,P<0.05)。结论DVRT技术可有效评估颅内动脉瘤介入栓塞术栓塞程度,对手术策略选择起到积极指导作用,并显著降低非致密栓塞术后并发症发生率。

Objective To discuss the application of dual volume reconstruction technique(DVRT)in evaluating interventional embolization degree of intracranial aneurysms,and to analyze its effect on the occurrence of postoperative complications.Methods A total of 112 patients with intracranial aneurysm(127 aneurysms in total),who received interventional embolization treatment between June 2016 and October2019,were enrolled in this study.The patients were randomly and equally divided into control group(n=56,adopting conventional evaluation method)and DVRT group(n=56,using DVRT evaluation method).In the control group,based on preoperative angiographic findings and 3D reconstruction images after anesthesia the best working angle was determined to perform the interventional embolization of aneurysm,the procedure was completed when 2D-DSA showed that a dense embolization was achieved.In DVRT group,3D data acquisition and DVRT were carried out after a 2D-DSA dense embolization was achieved.When an evaluation showed that a non-dense embolization existed,the further intervention was adopted,and when an evaluation indicated that a dense embolization was obtained the procedure was accomplished.Results In DVRT group no recurrent bleeding occurred,while in the control group the recurrent bleeding rate was 5.36%(3/56)(P<0.05).No statistically significant differences in the intraoperative used dose of contrast medium,X-ray radiation dose and surgical cost existed between the two groups(P>0.05).The total cerebrovascular DSA reexamination performed 3 months after treatment showed that in DVRT group and the control group the thrombosis occurred in one patient(1.8%)and 7 patients(12.5%)respectively,the recurrence of aneurysm in 0 patient(0.0%)and 6 patients(10.7%)respectively,and the cerebral infarction in 0 patient(0.0%)and 5 patients(8.9%)respectively;the differences in all the above indexes between the two groups were statistically significant(χ^(2)=4.846,6.340 and5.234 respectively,P<0.05).Conclusion DVRT can effectively evaluate the occlusion degree of intracranial aneurysm in performing interventional embolization treatment,which plays an important role in guiding the selection of surgical strategies and in reducing the incidence of complications caused by non-dense embolization of aneurysm.