手术夹闭与血管内栓塞对大脑中动脉瘤治疗效果的分析  

Effect analysis of surgical clipping and endovascular embolization in the treatment of middle cerebral artery aneurysms

作　　者：赵心同[1] 李真保[1] 方兴根[1] 吴德刚[1] 赖年升[1] 刘佳强[1] 

机构地区：[1]皖南医学院弋矶山医院神经外科,安徽省芜湖市241001

出　　处：《中国脑血管病杂志》2016年第1期8-12,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨手术夹闭与血管内栓塞治疗大脑中动脉瘤（MCAA）的效果。方法回顾性分析2011年10月至2015年2月87例MCAA的患者临床资料,分为手术治疗组29例（29个动脉瘤）与血管内治疗组58例（61个动脉瘤,对其中37个采取单纯弹簧圈栓塞,23个采取支架辅助弹簧圈栓塞,1个未进行治疗）。分析患者术中及术后病死率、临床和影像学随访结果。结果 （1）对于入院时Hunt-Hess分级0-Ⅲ级的患者,血管内治疗组与手术治疗组术后卒中并发症的发生率分别为20.0%（10/50）和29.4%（5/17）,差异无统计学意义（P=0.640）;经过3-40个月（中位数6个月）的门诊随访,血管内治疗组的病死率和预后良好率分别为4.2%（2/48）和95.8%（46/48）;经过3-19个月（中位数4个月）的随访,手术治疗组的病死率和预后良好率分别为6.2%（1/16）和81.2%（13/16）,两组差异有统计学意义（Z=-2.885,P=0.004）。（2）血管内治疗组经过3-40个月（中位数6个月）的影像学随访,40个动脉瘤有5个（12.5%）动脉瘤复发。手术治疗组经过1-31个月（中位数4个月）的随访,15个动脉瘤有3个（20.0%）动脉瘤残留或复发。结论血管内栓塞治疗对于Hunt-Hess分级0-Ⅲ级的MCAA患者是一种安全有效的治疗方法,对于不同MCAA患者的个性化治疗将会使患者获益。Objective To analyze the effect of endovascular embolization and surgical clipping for the treatment of middle cerebral artery aneurysms. Methods From October 2011 to February 2015,the clinical data of 87 patients with middle cerebral artery aneurysm were divided into either a surgical treatment group（ n = 29 with 29 aneurysms） or an endovascular treatment group（ n = 58 with 61 aneurysms,37 of the aneurysms were treated with coils alone,23 were treated with stent-assisted coil embolization,and 1 were not treated）. The intraoperative and postoperative complications,mortality,clinical and imaging follow-up results of the patients were analyzed. Results（ 1） For patients with Hunt-Hess grade 0- Ⅲ on admission,the incidence of postoperative stroke complications in the endovascular treatment group and the surgical treatment group were 20. 0%（ 10 /50） and 29. 4%（ 5 /17） respectively. There was no significant difference（ P = 0. 640）. After 3-40 months（ median 6 months） follow-up,the mortality and the good prognosis rates in the endovascular treatment group were 4. 2%（ 2 /48） and 95. 8%（ 46 /48） respectively. After 3-19 months（ median 4 months） follow-up,the mortality and the good prognosis rates in the surgical treatment group were 6. 2%（ 1 /16） and 81. 2%（ 13 /16） respectively. There were significant difference between the2 groups（ Z =- 2. 885,P = 0. 004）.（ 2） After 3-40 months（ median 6 months） imaging follow-up in the endovascular treatment group,5（ 12. 5 %） of the 40 aneurysms had recurrence. After 1- 31 months（ median 4 months） follow-up in the surgical treatment group,3（ 20. 0%） of the 15 aneurysms had residue or recurrence. Conclusion Endovascular embolization treatment is a safe and effective treatment for patients with middle cerebral artery aneurysm with Hunt-Hess Grade 0- Ⅲ. The individualized treatment will benefit patients with different types of middle cerebral artery aneurysms.

关 键 词：颅内动脉瘤 大脑中动脉瘤 显微外科手术 血管内介入治疗 预后 

分 类 号：R651.12[医药卫生—外科学]