血管内治疗与手术夹闭治疗颅内破裂动脉瘤的比较：单中心回顾性病例系列研究  

Comparative analysis of the efficacy of endovascular treatment and surgical clipping for intracranial ruptured aneurysms： a single-center retrospective case series study

作　　者：刘大军[1] 李粉根[1] 江夕庆 Liu Dajun;Li Fen＇gen;Jiang Xiqing(Department of Neurosurgery,the Second People＇s Hospital of Taizhou,Taizhou 225500,China)

机构地区：[1]泰州市第二人民医院神经外科,225500

出　　处：《国际脑血管病杂志》2018年第9期677-683,共7页International Journal of Cerebrovascular Diseases

摘　　要：目的 探讨血管内治疗与手术夹闭治疗颅内破裂动脉瘤的安全性和有效性.方法 回顾性纳入2012年1月至2017年12月在泰州市第二人民医院神经外科接受治疗的破裂颅内动脉瘤患者,对血管内治疗组与手术夹闭组人口统计学、基线临床资料、转归和并发症进行比较.结果 共纳入220例患者,年龄（55.1±11.8）岁.血管内治疗组117例,手术夹闭组103例,2组围手术期并发症（26.2％ 对19.6％;χ2=1.340,P=0.247）、院内病死率（6.0％ 对4.9％;χ2=0.135,P=0.713）和出院时转归良好率（85.5％ 对81.6％;χ2=0.614,P=0.433）差异均无统计学意义.多变量logistic回归分析显示,年龄[优势比（odds ratio,OR）1.072,95％ 可信区间（confidence interval,CI）1.025～1.124;P〈0.001]、吸烟（OR 6.325,95％CI 2.367～16.901;P〈0.001）和高世界神经外科医师联盟（World federation of Neurosurgical Societies,WFNS）分级（OR 5.218,95％CI 1.881～14.449;P〈0.001）与出院时临床转归不良存在显著独立相关性.155个动脉瘤（血管内治疗组81个,手术夹闭组74个）得到了影像学随访资料,随访时间为（14.3±6.9）个月（范围6～36个月）;20个动脉瘤（12.9％）复发,血管内治疗组复发率与手术夹闭组差异无统计学意义（17.3％ 对8.1％;χ2=2.900,P=0.089）.188例（血管内治疗组95例,手术夹闭组93例）得到了临床随访资料,随访时间为（15.5±6.8）个月（范围6～36个月）,血管内治疗组转归良好率与手术夹闭组差异无统计学意义（95.8％ 对90.3％;χ2=2.182,P=0.140）.多变量logistic分析显示,吸烟（OR 4.872,95％CI 1.719～13.872;P〈0.001）和高WFNS分级（OR 3.512,95％CI 1.446～8.583;P〈0.001）是远期转归不良的独立危险因素.结论手术夹闭治疗破裂颅内动脉瘤的疗效和安全性与血管内治疗相当.年龄、吸烟和WFNS分级是影响患者转归的重要因素.Objective To investigate the safety and effectiveness of endovascular treatment and surgical clipping for the treatment of intracranial ruptured aneurysms. Methods From January 2012 to December 2017, patients with ruptured intracranial aneurysm treated at the Department of Neurosurgery, the Second People＇s Hospital of Taizhou were enrolled retrospectively. The demographics, baseline clinical data,outcomes, and complications were compared between the endovascular treatment group and the surgical clip group. Results A total of 220 patients were enrolled, they aged 55. 1 ±11. 8 years. There were 117 patients in the endovascular treatment group and 103 in the surgical clipping group. There were no significant differences in perioperative complications （26. 2％ vs. 19. 6％; χ2 = 1. 340, P = 0. 247）, in-hospital mortality （6. 0％vs. 4. 9％; χ2 = 0. 135, P = 0. 713）, and good outcomes at discharge （85. 5％ vs. 81. 6％; χ2 =0. 614, P = 0. 433） between the two groups. Multivariate logistic regression analysis showed that age （odds ratio [OR] 1. 072, 95％ confidence interval [CI] 1. 025-1. 124; P 〈 0. 001）, smoking （OR 6. 325, 95％ CI 2. 367-16. 901; P 〈 0. 001 ）, and high World Federation of Neurosurgery Societies （WFNS） grade （OR 5. 218, 95％ CI 1. 881-14. 449; P 〈 0. 001） had significant independent correlation with the poor clinical outcome at discharge. The imaging follow-up data in 155 aneurysms （81 in the endovascular treatment group and 74 in the surgical clipping group） were available. The follow-up time was 14. 3 ± 6. 9 months （range, 6-36 months）; 20 aneurysms （12. 9％） had recurrence. There was no significant difference in the recurrence rate of the endovascular treatment group and surgical clipping group （17. 3％ vs. 8. 1％; χ2 =2. 900, P = 0. 089）. The clinical follow-up data of 188 patients （95 in the endovascular treatment group and 93 in the surgical clipping group） were available. The follow-up time was 15. 5 ± 6. 8 months （range

关 键 词：颅内动脉瘤 动脉瘤 破裂 栓塞 治疗性 血管内手术 神经外科手术 治疗结果 

分 类 号：R651.12[医药卫生—外科学]