支架结合弹簧圈与单纯支架植入治疗颅内宽颈动脉瘤临床疗效比较  

Clinical efficacy of stenting combined with coiling versus simple stenting for the treatment of intracranial wide-necked aneurysm

作　　者：余翔[1] 梁辉[1] 彭熠[1] 赵志鸿[1] 

机构地区：[1]湖南省人民医院神经内科,湖南长沙410005

出　　处：《中国临床研究》2017年第5期620-622,共3页Chinese Journal of Clinical Research

基　　金：湖南省科技支撑计划一般项目(2008SK3057)

摘　　要：目的对比支架结合弹簧圈与单纯支架植入治疗颅内宽颈动脉瘤临床疗效的差异,并探讨宽颈动脉瘤血管内治疗具体方法的选择。方法回顾性分析2015年3月至2016年9月收治的颅内宽颈动脉瘤病例手术资料共68例,按治疗方法的不同,分为支架结合弹簧圈治疗组(n=47)和单纯支架植入治疗组(n=21),比较两组术中出血风险,术后栓塞效果及预后效果。结果支架结合弹簧圈治疗组发生术中出血7例(14.89%),单纯支架植入治疗组发生术中出血2例(9.52%),两组比较差异无统计学意义(χ2=0.047,P=0.829)。支架结合弹簧圈治疗方法不会增加术中出血的风险。单纯支架植入治疗组术后不全栓塞、次全栓塞、完全栓塞分别为1、3、17例;支架结合弹簧圈治疗组术后不全栓塞、次全栓塞、完全栓塞分别为0、0、47例;支架结合弹簧圈治疗组对瘤颈的覆盖栓塞效果明显优于单纯支架植入治疗组(χ2=9.512,P=0.009)。支架结合弹簧圈治疗组预后效果满意率明显优于单纯支架植入治疗组(95.74%vs 80.95%,χ2=3.948,P=0.047)。结论支架结合弹簧圈血管内介入治疗颅内宽颈动脉瘤效果优于单纯支架治疗,支架结合弹簧圈的治疗方法应优先选择。Objective To compare clinical efficacy of stenting combined with coiling and simple stent implantation for the treatment of intracranial wide-necked aneurysm to choose a proper method of endovascular treatment. Methods Retrospective analysis was performed on operative data of 68 patients with intracranial wide-necked aneurysm treated from March 2015 to September 2016. The patients were divided into stenting combined with coiling group （n = 47 ） and stenting alone group （n = 21 ） according to treatment method. Intraoperative bleeding danger, postoperative embolization effect and prognosis [ evaluation according to the modified Rankin scale （MRS） ~ were compared between two groups. Results The intraoperative bleeding was 7 cases （ 14. 89% ） in stenting combined with coiling group and 2 cases （9. 52% ） in stenting alone group, and there was no significant difference between two groups （X2 = 0. 047, P = 0. 829 ） , namely, stenting combined with coiling method did not increase the risk of intraoperative bleeding. Incomplete embolization, subtotal embolization and complete embolization were l case,3 cases and 17 cases,respectively in stenting alone group,while they were 0,0 and 47 cases, respectively in stenting combined with coiling group, so the effect of stenting combined with coiling on coverage and embolization of tumor neck of ancurysm was obviously better than simple stent implantation （95.74% vs 80. 95% ,X2 = 3.948, P = 0. 047 ）. Conclusion The effect of stent combined with spring coil endovascular interventional treatment for the treatment of intracranial wlde-necked aneurysm is better than the sinlple stent implantation, so stent combined with spring coil embolization should be preferred.

关 键 词：单纯支架植入 支架结合弹簧圈 颅内宽颈动脉瘤 术中出血 栓塞效果 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]