颅内动脉瘤破裂早期显微手术与血管内栓塞治疗的疗效对比分析  

Comparison in curative effects of early surgical treatment and endovascular embolization for ruptured intracranial aneurysm

作　　者：陈立一[1] 王东军[2] 毛伯镛[2] 龙霄翱[1] 

机构地区：[1]广东医学院附属医院神经外科,湛江524001 [2]四川大学华西医学中心,成都610041

出　　处：《中华神经医学杂志》2007年第4期378-380,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨颅内动脉瘤破裂早期显微手术与血管内栓塞治疗的临床疗效。方法150例颅内动脉瘤破裂分别在3d内早期经显微手术或血管内栓塞治疗,其中52例显微手术,98例经血管内栓塞:随访12个月:术前术后行TCD监测。结果52例行显微手术者中院内死亡3例;12个月后GOS评分:5分(恢复良好)28例、4分(轻度致残)14例、3分(严重致残)4例、1分(死亡)3例。98例行血管内栓塞治疗者中院内死亡5例;随访12月,GOS评分:5分72例,4分13例,3分4例,1分4例。两种治疗方法比较发现,血管内栓塞疗效较显微手术好,疗效良好率血管内栓塞治疗组较优,完全栓塞率早期经显微手术较优(P<0.05),再出血率和脑血管痉挛(CVS)发生率两组差异无显著性意义(P>0.05)。结论显微手术与血管内栓塞治疗动脉瘤破裂方法各有所长,还不能相互取代,有些患者两种方法结合应用效果更佳。Objective To analyze the curative effects of early microsurgical and endovascular embolization treatments for the ruptured intracranial aneurysms. Methods Of 150 cases with ruptured intracranial aneurysms, 52 were treated by early microsurgery and 98 by endovascular embolization. The follow-up averaged 12 months; transcranial Doppler （TCD） monitoring was carried out pre- and post-operatively. Results In 52 patients receiving microsurgery, 3 patients died in hospital; according to GOS scores 12 months after operation, 5 scores （satisfactory recovery） were obtained in 28 patients, 4 scores （mild disability） in 14, 3 scores （severe disability） in 4 and 1 （death） in 3. In 98 patients receiving endovascular embolization, 5 patients died in hospital; according to GOS scores 12 months after treatment, 5 scores were achieved in 72 patients, 4 scores in 13, 3 scores in 4 and 1 in 4. In comparison between the 2 treatments, endovascular embolization was better in the curative effects and satisfactory recovery rate, while microsurgery was superior in the complete embolization rate（P〈0.05）; the two were not different significantly in the incidences of rebleeding and CVS （P〉0.05）. Conclusion Both microsurgery and endovascular embolization have their merits, and don＇t replace each other. Some cases may attain better results by using two techniques together.

关 键 词：颅内动脉瘤 血管内栓塞 显微外科手术 

分 类 号：R651[医药卫生—外科学]