血管内介入栓塞术与开颅夹闭术治疗脑动脉瘤疗效观察

Comparative study of intravascular interventional embolization and craniotomy clipping in the treatment of cerebral aneurysms

目的比较血管内介入栓塞术与开颅夹闭术治疗脑动脉瘤的临床疗效。方法回顾性分析龙岩人民医院神经外科于2017年1月至2020年10月期间收治的150例脑动脉瘤患者的临床资料,其中80例接受开颅夹闭术治疗者纳入开颅组,70例接受血管介入术治疗者纳入介入组。比较两组患者的手术时间、术中出血量、手术费用、术后住院时间、专科及一般并发症发生率;术后对两组患者均随访6个月,比较两组患者的格拉斯哥预后评分(GOS)优良率。结果介入组患者术中出血量为(39.45±12.23)mL,明显少于开颅组的(254.63±71.25)mL,手术时间及住院时间分别为(2.15±0.70)h、(11.24±3.11)d,明显短于开颅组的(2.98±0.88)h、(18.54±3.95)d,但是介入组患者的手术费用为(6.78±2.22)万元,明显高于开颅组的(3.32±1.03)万元,差异均有统计学意义(P<0.05);介入组与开颅组患者术后专科并发症发生率分别为15.71%、22.50%,差异无统计学意义(P>0.05);介入组患者术后一般并发症发生率为11.43%,明显低于开颅组的23.75%,差异有统计学意义(P<0.05);术后6个月,介入组患者的优良率为84.29%,明显高于开颅组的62.50%,差异有统计学意义(P<0.05)。结论血管内介入栓塞术治疗脑动脉瘤相对于开颅夹闭术可以取得更好的临床疗效,并且具有明显的微创优势。但是目前血管介入术费用相对较高,在经济条件允许的前提下可作为本病的首选手术方式。

Objective To compare the clinical effects of intravascular interventional embolization and craniotomy clipping in the treatment of cerebral aneurysms.Methods The clinical data of 150 patients with cerebral aneurysms treated in the Department of Neurosurgery,Longyan People's Hospital from January 2017 to October 2020 were analyzed retrospectively.Eighty patients treated with craniotomy clipping were included into the craniotomy group,and 70 patients treated with vascular intervention were included into the intervention group.The perioperative related indexes were compared,including operation time,intraoperative bleeding,operation cost,postoperative hospital stay,and the incidence of specialized and general complications.The patients in both groups were followed up for 6 months,and the excellent and good rate of GOS were compared.Results The amount of intraoperative bleeding in the intervention group was(39.45±12.23)mL,significantly less than(254.63±71.25)mL in the craniotomy group;the operation time and length of hospital stay in the intervention group were(2.15±0.70)h and(11.24±3.11)d,respectively,significantly less than(2.98±0.88)h and(18.54±3.95)d in the craniotomy group;the operation cost in the intervention group was(6.78±2.22)×104 yuan,significantly higher than(3.32±1.03)×104 yuan in the craniotomy group;the differences were statistically significant(P<0.05).The incidence of postoperative complications in the intervention group was 15.71%,which showed no statistically significant difference with 22.50%in the craniotomy group(P>0.05).The incidence of postoperative general complications in the intervention group was 11.43%,significantly lower than 23.75%in the craniotomy group(P<0.05).Six months after operation,the excellent and good rate in the intervention group was 84.29%,significantly higher than 62.50%in the craniotomy group(P<0.05).Conclusion Intravascular interventional embolization in the treatment of cerebral aneurysms can achieve better clinical efficacy compared with craniotomy clipping,and has obvious minimally invasive advantages.However,at present,the cost of intravascular interventional embolization is relatively high,and it can be used as the first choice for the disease on the premise of economic conditions.