血管内栓塞与开颅夹闭治疗破裂后交通动脉瘤的对比研究  

Comparative study of surgical clipping and endovascular embolization in the treatment of ruptured posterior communicating artery aneurysms

作　　者：李文帅[1] 张信芳[1] 徐文涛[1] 郭西文[1] 王刚[1] 姜海涛[1] 张宏图[1] 任建军[1] 梁宪坤[1] 张全忠[1] Li Wenshuai, Zhang Xinfang, Xu Wentao, Guo Xiwen, Wang Gang, Jiang Haitao, Zhang Hongtu, Ren Jianjun, Liang Xiankun, Zhang Quanzhong(Department of Neurosurgery, Heze Municipal Hospital, Heze, Shandong 274000, Chin)

机构地区：[1]菏泽市立医院神经外科,274000

出　　处：《中国微侵袭神经外科杂志》2018年第3期111-114,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨血管内栓塞与开颅夹闭治疗破裂后交通动脉瘤(PCoAA)的有效性与安全性。方法回顾性分析122例破裂PCoAA病人的临床资料,按治疗方法不同,分为夹闭组32例和栓塞组90例,其中栓塞组又分为两个亚组:弹簧圈组46例、支架组44例。分析术后相关并发症,术后1、6个月mRS评分及影像学随访结果。结果栓塞组与夹闭组术中、术后症状性卒中并发症的发生率均无显著差异(P>0.05),两组术后1、6个月的预后良好率亦无显著差异(P>0.05)。动脉瘤复发率比较:夹闭组与栓塞组、夹闭组与弹簧圈组、支架组与弹簧圈组差异均有统计学意义(P<0.05),而夹闭组与支架组无明显差异(P>0.05)。结论栓塞与夹闭治疗Hunt-HessⅠ～Ⅲ级破裂PCoAA预后相当,支架组和夹闭组动脉瘤复发率明显低于弹簧圈组。Objective To evaluate the safety and efficacy of endovascular embolization and clipping in the treatment of ruptured posterior communicating artery aneurysm（PCoAA）. Methods Clinical data of 122 patients with ruptured PCoAA were analyzed retrospectively, and the patients were divided into clipping group（n = 32） and embolization group（n = 90）. Then, the embolization group were divided into coil subgroup（n = 44） and stent subgroup（n = 46）. The procedure-related complications, mRS 1, 6 months after operation, imaging follow-up results were analyzed. Results There were no significant differences in the incidences of intraoperative and postoperative stroke complications and the good prognosis rates 1, 6 months after operation between clipping group and embolization group（P 〉 0.05）. There was a significant difference in recurrence rate of aneurysms between clipping group and embolization group（P 〈 0.05）, and the same to clipping group versus coil subgroup, coil subgroup versus stent subgroup, while no significant difference was found between clipping group and stent subgroup（P 〉 0.05）. Conclusions Both endovascular embolization and clipping are safe and effective treatment for PCoAA patients with Hunt-Hess grade Ⅰto Ⅲ. The recurrence rates of the clipping group and stent subgroup may be obviously lower than coil subgroup.

关 键 词：颅内动脉瘤 后交通动脉 介入栓塞 开颅夹闭 

分 类 号：R651.122[医药卫生—外科学]