支架辅助弹簧圈栓塞颅内破裂宽颈囊性动脉瘤的并发症及预后影响因素分析  

Complication and prognosis factor analysis of stent.assisted coil embolization for ruptured widenecked saccular intracranial aneurysms

作　　者：薛锦[1] 陈姝娟[1] 文立利[1] 张翔圣[1] 吕盛银 邓金龙[1] 吴琪[1] 张庆荣[1] 王汉东[1] 张鑫[1] Xue Jin Chen Shujuan Wen Lili Zhang Xiangsheng Lyu Shengyin Deng Jinlong Wu Qi Zhang Qingrong Wang Handong Zhang Xin.(Department of Neurosurgery, Nanjing General Hospital of Nanjing Military Command,Nanjing 210002, China)

机构地区：[1]南京军区南京总医院神经外科,210002

出　　处：《中华神经外科杂志》2017年第4期339-343,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨影响支架辅助弹簧圈栓塞治疗颅内破裂宽颈囊性动脉瘤的并发症和预后的相关因素。方法回顾性分析2008年3月至2015年12月南京军区南京总医院神经外科行支架辅助弹簧圈栓塞的147例颅内破裂宽颈囊性动脉瘤患者的临床资料。以改良Rankin量表评分（mRS）评估患者的预后。采用单因素和多因素Logistic回归分析寻找手术相关并发症的发生以及患者预后的影响因素。结果手术相关并发症的发生率为17．7％（26／147），动脉瘤的部位（P=0．002）和大小（P=0．028）可能为手术相关并发症发生的危险因素。预后良好患者占比85．0％（125／147）。单因素分析结果表明，年龄〉65岁（P=0．041）和入院Hunt-Hess分级较高（P〈0．001）可能与出院时mRS评分较高有关。多因素Logistie分析表明，高Hunt—Hess分级（OR：28．790，95％CI：8．091～102．446，P〈0．001）和大型动脉瘤（OR：0．149，95％CI：0．030～0．734，P=0．019）为出院时mRS评分的独立影响因素。而对于短期预后而言，仅Hunt-Hess分级为其可能的影响因素（P〈0．001）。结论支架辅助弹簧圈栓塞治疗颅内破裂宽颈囊性动脉瘤是安全有效的。大脑中动脉动脉瘤和大型动脉瘤为手术相关并发症发生的危险因素。年龄〉65岁、入院时高Hunt-Hess分级、大型动脉瘤为出院时mRS评分不佳的危险因素；入院时Hunt—Hess分级较高可能是患者短期预后的影响因素。Objective To investigate the factors influencing the complications and prognosis of stent-assisted coil embolization （SACE） for ruptured wide-necked saccular intracranial aneurysms. Methods A retrospective analysis was conducted about the clinical data of 147 patients with ruptured wide- necked saccular intracranial aneurysms who underwent SACE from March 2008 to December 2015 at Department of Neurosurgery, Nanjing General Hospital of Nanjing Military Command. The modified Rankin Scale （mRS） was used to assess the patients＇ outcomes. Univariate and multivariate Logistic regression were utilized to identify the factors influencing the related complications and prognosis. Results Surgery- related complications occurred in 26 patients （ 17.7% ） out of 147 cases. The location （P = 0. 002） and size （P = 0. 028 ） of intracranial aneurysms might be risk factors of the complications. Among all patients, 125 （85.0%） achieved good clinical outcome. The univariate analysis revealed that the patient% age over 65 （ P = 0. 041 ） and relatively high Hunt-Hess grade at admission （ P 〈 0. 001 ） might be associated with high mRS at the time of discharge. The analysis using multivariate Logistic regression demonstrated that the HuntHess grade （ 0R,28. 790, 95% CI 8. 091 - 102. 446, P 〈0. 001 ） and aneurysm size （ OR,0. 149, 95% CI 0. 030 -0. 734, P = 0. 019 ） were independent factors influencing the patient＇s mRS at the time of discharge, while the short-term outcome was only associated with the Hunt-Hess grade （ P 〈 0. 001 ）. Conclusions The treatment of SACE seems to be a safe and effective procedure for ruptured wide-necked saccular intracranial aneurysms. Middle cerebral artery aneurysms and large aneurysms might be the risk factors of surgical complications. The patient＇s age over 65, high Hunt-Hess grade on admission and large size of aneurysm could be associated with poor outcome at the time of discharge assessed by mRS. High Hunt-Hess grade might be a significant facto

关 键 词：颅内动脉瘤 栓塞 治疗性 支架 手术后并发症 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]