高级别颅内动脉瘤治疗策略探讨  

Strategies for treatment of poor - grade patients with ruptured intracranial aneurysms

作　　者：秦尚振[1] 马廉亭[1] 杨铭[1] 李俊[1] 姚国杰[1] 张新元[1] 徐国政[1] 龚杰[1] 潘力[1] 陈刚[1] 胡军民[1] 杜浩[1] 张戈[1] 秦海林[1] 

机构地区：[1]广州军区武汉总医院神经外科,中国人民解放军神经外科研究所, 430070

出　　处：《中华神经外科杂志》2013年第9期916-919,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨高级别（Hunt—HessⅣ～Ⅴ级）颅内动脉瘤治疗方法和治疗时机选择。方法回顾性分析2000年1月至2011年12月Ⅳ～V级颅内动脉瘤304例，其中显微手术夹闭216例，血管内栓塞88例。结果按GOS评分，显微手术夹闭组Ⅳ级192例中5分和4分94例，良好率49％；2分和1分38例，极差率19．8％。V级24例中2分和1分19例，极差率79．2％。栓塞组中Ⅳ级78例中良好40例，良好率51．3％；2分和1分14例，极差率17．9％。V级lO例，1分9例，极差率90％。结论Ⅳ级在3d内要积极治疗（手术或栓塞），3d后血管痉挛严重者应保守治疗，待病情好转后再治疗。V级动脉瘤除非发病时间不长（2h内）或有明显血肿，否则不宜选择手术干预治疗，如要手术则宜选择显微手术夹闭。Objective To summarize the experience in treating poor- grade patients with ruptured intraeranial aneurysms and to explore the methods and timing for treatment of these patients. Methods The clinical data of 304 patients with ruptured intraeranial aneurysms of Hunt - Hess grade Ⅳ～Ⅴ, who were admitted to our hospital from January, 2000 to December, 2011, were analyzed retrospectively. Of 304 patients, 216 received microsurgical clipping and 88 received endovaseular embolization. Results The prognosis was assessed by Glaseow outcome scale （GOS） , and good and poor outcomes were defined as GOS score of 4 -5 and 1 -2. Of 216 patients who received microsurgieal clipping, good outcomes were achieved by 94 of 192 （49.0%） and poor outcomes by 38 of 192 （ 19. 8% ） in patients of Hunt - Hess grade IV, and poor outcomes by 19/24 （79. 2% ） in patients of Hunt - Hess grade V. Of 78 patients who received endovascular embolization, good outcomes were achieved by 40 of 78 （51.3%） and poor outcomes by 14 of 78 （ 17.9% ） in patients of Hunt - Hess grade IV, and poor outcomes by 9/10 （90. 0% ） in patients of Hunt- Hess grade V. Conclusions The patients of Hunt - Hess grade IV should be treated with mierourgical clipping or endovaseular embolization within 3 days after subarachnoid hemorrhage, but the patients whose subarachnoid hemorrhage is more than 3 days and cerebrovasospasm is severe should be treated conservatively until their condition improved after conservative treatment. While the patients of Hunt - Hess grade V should be treated conservatively unless the operative time is no more than 2 hour or there is occurrence of large hematoma. If surgical intervention is needed, microsurgical clipping is preferable to endovascular embolization for the patients of Hunt - Hess grade V.

关 键 词：高级别颅内动脉瘤 显微手术 血管内治疗 

分 类 号：R739.41[医药卫生—肿瘤]