动脉瘤介入栓塞术与显微外科夹闭术治疗Hunt-HessⅠ~Ⅲ级破裂动脉瘤的疗效比较

Efficacy of aneurysm interventional embolization and microsurgical clipping in the treatment of Hunt-Hess gradeⅠ-Ⅲruptured aneurysms

目的比较动脉瘤介入栓塞术与显微外科夹闭术治疗Hunt-HessⅠ~Ⅲ级破裂动脉瘤的疗效。方法回顾性分析2019-09—2022-09达州市中心医院收治的Hunt-HessⅠ~Ⅲ级破裂动脉瘤患者的临床资料,按照手术方式不同分为栓塞组(采用动脉瘤介入栓塞术,102例)和夹闭组(采用显微外科夹闭术,106例)。记录2组患者手术指标(手术时间、术中出血量和住院时间),术后并发症发生情况,比较2组患者术前及术后1个月美国国立卫生研究院卒中量表(NIHSS)评分和改良Barthel指数(MBI),比较2组患者术后6个月预后结果[格拉斯哥预后评分(GOS)]及影像学结果(复发、残留稳定、动脉瘤消失),分析患者预后多因素危险因素。结果栓塞组手术和住院时间显著低于夹闭组(P<0.05),2组患者并发症发生情况比较无统计学差异(P>0.05)。术后1个月,2组患者NIHSS评分均降低(P<0.05),MBI均升高(P<0.05),但2组患者间NIHSS和MBI差异无统计学意义(P>0.05)。2组患者术后6个月预后结果比较无统计学差异(P>0.05),但栓塞组复发率显著高于夹闭组(P<0.05),动脉瘤消失状态低于夹闭组(P<0.05)。预后良好患者178例(85.58%),预后不良共30例(14.42%),单因素变量分析,Hunt-Hess分级和动脉瘤直径差异有统计学意义(P<0.05),2组患者性别、年龄、动脉瘤部位、手术方式以及术后相关并发症比较,差异无统计学意义(P>0.05);多因素二元Logistic回归分析提示Hunt-Hess分级和动脉瘤直径是患者术后的独立危险因素(P<0.05)。结论动脉瘤介入栓塞术应用于Hunt-HessⅠ~Ⅲ级破裂动脉瘤患者可以有效缩短手术及住院时间,降低术后并发症发生率,但术后复发率及动脉瘤消失状态较差于显微外科夹闭术。患者预后与Hunt-Hess分级、动脉瘤直径密切相关。

Objective To compare the efficacy of aneurysm interventional embolization and microsurgical clipping in the treatment of Hunt-Hess gradeⅠ-Ⅲruptured aneurysms.Methods The data of patients with Hunt-Hess gradeⅠ-Ⅲruptured aneurysms admitted to the Dazhou central Hospital from September 2019 to September 2022 were retrospectively analyzed,and the patients were divided into embolization group(aneurysm interventional embolization,102 cases)and clipping group(microsurgical clipping,106 cases)according to different surgical methods.Surgical indicators(surgical time,intraoperative blood loss and hospital stay)and occurrence of postoperative complications were recorded in the two groups.National Institutes of Health stroke scale(NIHSS)score and modified Barthel index(MBI)before surgery and at 1 month after surgery and prognosis results[Glasgow outcome scale(GOS)]and imaging results(recurrence,residual stability,disappearance of aneurysms)at 6 months after surgery were compared between the two groups.Multivariate risk factors for prognosis of patients were analyzed.Results The surgical time and hospital stay were significantly shorter or less in embolization group than those in clipping group(P<0.05).There were no significant differences in the occurrence of complications between the two groups(P>0.05).At 1 month after surgery,the NIHSS score in both groups was declined(P<0.05),while the modified Barthel index was risen(P<0.05),but there were no statistical difference in the NIHSS and modified Barthel index between both groups(P>0.05).There were no significant differences in the prognosis results at 6 months after surgery between the two groups(P>0.05).However,the recurrence rate in embolization group was significantly higher than that in clipping group(P<0.05),and the disappearance state of aneurysm was lower than that in clipping group(P<0.05).There were 178 cases(85.58%)with good prognosis and 30 cases(14.42%)with poor prognosis.Univariate analysis showed that there were statistical differences in the Hunt-Hess grading and aneurysm diameter(P<0.05),but there were no statistically significant differences between the two groups in terms of gender,age,aneurysm site,surgical method and postoperative related complications(P>0.05).Multivariate binary Logistic regression analysis indicated that Hunt-Hess grading and aneurysm diameter were postoperative independent risk factors(P<0.05).Conclusion The application of aneurysm interventional embolization in patients with Hunt-Hess gradeⅠ-Ⅲruptured aneurysms can effectively shorten the surgical time and hospital stay and reduce the incidence rates of postoperative complications,but its postoperative recurrence rate and disappearance state of aneurysms are worse than those of microsurgical clipping.The prognosis of patients is closely related to Hunt-Hess grading and aneurysm diameter.