颅内破裂动脉瘤早期显微手术与血管内栓塞治疗的临床应用  

Comparative study on initial microsurgery and endovascular embolization for ruptured intracranial aneurysms

作　　者：袁坚列[1] 周格知[1] 章威[1] 单国进[1] 郭晓华[1] 鲍翔[1] 施秋勤[1] 刘继红[1] 吴晓华[1] 王珏基[1] 

机构地区：[1]金华市中心医院神经外科,321000

出　　处：《浙江医学》2010年第9期1286-1289,共4页Zhejiang Medical Journal

基　　金：浙江省卫生厅省市共建项目（2010SSA007）

摘　　要：目的 分析颅内破裂动脉瘤早期行显微手术与血管内介入治疗的临床疗效,探讨对不同形式的颅内动脉瘤及不同病情患者的治疗方法.方法 对214例颅内破裂动脉瘤患者早期（起病3d内）采用显微手术或血管内介入治疗,根据患者入院时的Hunt-Hess（HHS）病情分级结合治疗后1个月时患者的格拉斯哥预后评分（GOS）分析其治疗结果,其中显微手术128例（HHS Ⅳ～Ⅴ级占30例）,经血管内栓塞86例（HHS Ⅳ～Ⅴ级占17例）.结果 98例HHS Ⅰ～Ⅲ级显微手术者1个月后GOS评分5分（恢复良好）76例,4分（轻度残疾）13例,3分（严重残疾）6例.2分（植物生存）2例,1分（死亡）1例;69例HHS Ⅰ～Ⅲ级血管内介入治疗者1个月后GOS评分5分54例,4分9例,3分4例,2分1例,1分1例,两组HHS Ⅰ～Ⅲ级患者治疗效果的差异无统计学意义（P〉0.05）.30例HHS Ⅳ～Ⅴ级显微手术者1个月后GOS评分5分8例,4分6例,3分8例,2分4例,1分4例;17例HHS Ⅳ～Ⅴ级血管内栓塞治疗者1个月后GOS评分5分2例,4分2例,3分2例,2分4例,1分7例,两组HHS Ⅳ～Ⅴ级患者治疗效果的差异有统计学意义（P〈0.01）.结论 HHS Ⅰ～Ⅲ级动脉瘤患者显微手术与血管内介入治疗疗效无明显差异,而Ⅳ～Ⅴ级动脉瘤患者倾向于显微手术治疗,部分患者联合应用两种方法效果更好,远期疗效还需要长期随访.Objective To compare microsurgery and endovascular embolization in treatment of ruptured intracranial aneurysms. Methods Two hundred and fourteen patients with ruptured intracranial aneurysms with 3 days were assigned to microsurgery or endovascular embolization groups. The therapeutic effects were analyzed according to Hunt-Hess standard （HHS） of admit-patients and GOS grade at one month after treatment. Results Ninety eight patients of HHS Ⅰ～Ⅲ received micro- surgery, according to the GOS grade one month after operation, 5 scores （satisfactory recovery） were obtained in 76 patients, 4 scores （mild disability） in 13, 3 scores （severe disability） in 6, 2 scores （vegetative state ） in 2 and 1 score （death） in 1; among 69 patients receiving endovascular embolization, 5 scores were obtained in 54, 4 scores in 9,3 scores in 4,2 scores in 1 and 1 score in 1. Thirty patients of HHSVINV received microsurgery, 5 scores were obtained in 8, 4 scores in 6, 3 scores in 8, 2 scores in 4 and 1 score in 4; among 17 patients of HHSVI^V after endovascular embolization, 5 scores were obtained in 2,4 scores in 2,3 scores in 2,2 scores in 4 and 1 score in 7, There were no statistical differences in therapeutic effects between the two groups of HHS Ⅰ～Ⅲ （P〉 0.05）, but were significant differences between the two groups of HHSVI-V （P〈 0.01）. Conclusions For HHS Ⅰ～Ⅲ patients there is no significant difference between microsurgery and endovascular embolization, while for HHS Ⅳ～Ⅴ-V patients mi- crosurgery may have better results than endovascular embolization in treatment of intracranial ruptured aneurysms.

关 键 词：颅内动脉瘤 显微手术 血管内介入治疗 

分 类 号：R739.41[医药卫生—肿瘤]