显微手术夹闭与血管介入栓塞术对大脑中动脉瘤破裂延迟性脑缺血的疗效比较

Microsurgical clipping versus endovascula Rembolization in treating delayed cerebral ischemia after rupture of middle cerebral artery aneurysm

目的比较显微手术夹闭与血管介入栓塞术治疗大脑中动脉瘤破裂的疗效及对延迟性脑缺血的影响。方法回顾性收集96例大脑中动脉瘤破裂患者的临床资料,其中65例行显微手术夹闭治疗者设为显微手术组,31例行血管内介入栓塞术者设为介入栓塞组。比较2组手术前后的免疫功能指标、炎性指标、围术期指标、延迟性脑缺血发生率、预后等。结果与显微手术组相比,介入栓塞组的手术时间更短,术中出血量更低,治疗费用更高,差异有统计学意义(P<0.05)。与术前相比,2组术后3 d的免疫球蛋白G(IgG)、免疫球蛋白M(IgM)及免疫球蛋白A(IgA)水平降低,且显微手术组的IgG、IgM及IgA水平更低,差异有统计学意义(P<0.05)。2组术后3 d的纤维蛋白原(Fib)及肿瘤坏死因子-α(TNF-α)水平较术前升高,且介入栓塞组术后3 d的Fib及TNF-α水平均低于显微手术组,差异有统计学意义(P<0.05)。2组延迟性脑缺血发生率、脑缺血死亡率、术后并发症总发生率比较,差异无统计学意义(P>0.05)。介入栓塞组的Barthel指数评分、术后复发率高于显微手术组,差异有统计学意义(P<0.05)。结论显微手术夹闭与血管内介入栓塞术均是治疗大脑中动脉瘤破裂的有效手段,但血管内介入栓塞术创伤更小,免疫抑制更轻,可能对降低术后延迟性脑缺血发生风险有益,但术后复发率也较高,治疗费用更高。

Objective To compare the effects of microsurgical clipping and endovascular embolization in treating rupture of middle cerebral artery aneurysm and theiRinfluences on delayed cerebral ischemia.Methods The clinical materials of 96 patients with rupture of middle cerebral artery aneurysm were retrospectively collected,including 65 patients with microsurgical clipping(microsurgery group)and 31 patients with endovascular embolization(embolization group).Preoperative and postoperative immune function indicators,inflammatory indicators,perioperative indicators,incidence of delayed cerebral ischemia,and prognosis before and after surgery were compared between the two groups.Results Compared with the microsurgery group,the embolization group had shorter operation time,less intraoperative bleeding volume and higher therapeutic cost,and the differences were statistically significant(P<0.05).Three days after operation,the levels of immunoglobulin G(IgG),immunoglobulin M(IgM)and immunoglobulin A(IgA)in both groups were significantly lower than those before operation,and the levels of IgG,IgM and IgA in the microsurgery group were significantly lower than those in the embolization group(P<0.05).Three days after operation,the levels of fibrinogen(Fib)and tumor necrosis factor-α(TNF-α)in both groups were significantly higher than those before operation,and the levels of Fib and TNF-αin the embolization group were significantly lower than those in the microsurgery group(P<0.05).There were no significant differences in the incidence rates of delayed cerebral ischemia,mortality of cerebral ischemia and total incidence of postoperative complications between the two groups(P>0.05).The score of Barthel index and postoperative recurrence rate in the embolization group were significantly higher than those in the microsurgery group(P<0.05).Conclusion Both microsurgical clipping and endovascular embolization are effective methods for treating rupture of middle cerebral artery aneurysm,but endovascular embolization causes less trauma and milder immune suppression,which may be beneficial for reducing the risk of delayed cerebral ischemia after surgery.However,the postoperative recurrence rate and the treatment cost are higher for endovascular embolization.