低分级颅内动脉瘤手术与介入术后复发因素分析  

Influencing factors on recurrence of low grade intracranial aneurysm treated with surgical clipping or endovascular embolization therapy

作　　者：何伟[1] 王志刚[1] 丁璇[1] 王成伟[1] 王益华[1] 姜彬[1] 韩超[1] 

机构地区：[1]山东大学第二医院神经外科,济南250033

出　　处：《山东大学学报（医学版）》2013年第7期54-57,共4页Journal of Shandong University:Health Sciences

基　　金：山东省科技发展计划项目(2011GGE27079)

摘　　要：目的探讨低分级颅内囊状动脉瘤手术夹闭与介入栓塞治疗的复发率及复发因素,以预测动脉瘤复发危险性。方法 420例(474个)低分级囊状动脉瘤中,采用手术夹闭242例(282个),介入栓塞178例(192个)。术后经脑血管造影随访,对动脉瘤复发的影响因素进行分类;分析年龄,性别,高血压史,动脉瘤的部位、大小、瘤颈、栓塞材料、栓塞方式、栓塞程度等与动脉瘤复发的关系。结果术后随访3～42个月,手术夹闭组复发率0.71%(2/282),低于介入栓塞组(17.19%,33/192),P<0.05。结论手术夹闭和介入栓塞治疗低分级颅内动脉瘤效果肯定,夹闭不全是手术夹闭复发的主要因素,大脑前动脉、宽颈、非生物圈、栓塞不全及弹簧圈直接栓塞是影响介入栓塞术后复发的独立危险因素。Objective To predict the recurrence risk of aneurysm by comparing recurrence rates and analyze factors causing recurrence in cases of low grade intracranial saccular aneurysm treated with clipping surgery and endovascular coiling. Methods Cerebral angiographic follow-up was taken for a total of 420 low grade patients with 474 saccular aneurysms, which were treated with endovascular coiling（ 192 aneurysms in 178 cases） or clipping surgery （282 aneu- rysms in 242 cases）, and the recurrence factors were classified and the relationships between factors including age, gen- der, coiling degree, location, tumor neck, size, coiling materials, coiling method, and hypertension history, and the recurrence of aneurysm were analyzed. Results After 3-42 months＇ follow-up, recurrence rate in surgical clipping group （0.71% ） was lower than endovascular embolization group （ 17.19% ） （ P 〈 0.05 ）. Conclusion The effect of preventing rehaemorrhagia through surgical clipping and endovascular embolization to low grade aneurysm is certain. Clipping insufficiency and residual aneurysm neck are chief factors of aneurysm recurrence after surgical clipping. While aneurysm＇s location, neck, size, embolic material and embolism way are independent risk factors which influence the recurrence after surgery.

关 键 词：颅内动脉瘤 低分级 随访 复发因素 

分 类 号：R651.1[医药卫生—外科学]