老年动脉瘤性蛛网膜下腔出血患者的治疗:手术夹闭与血管内弹簧圈栓塞比较  

Treatment of elderly patients with aneurysmal subarachnoid hemorrhage:comparison between surgical clipping and endovascular coil embolization

作　　者：刘超博 任力 徐豪 邢进 黄焕斌 王之涵 汪锡华 Liu Chaobo;Ren Li;Xu Hao;Xing Jin;Huang Huanbin;Wang Zhihan;Wang Xihua(Department of Neurosurgery,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201399,China)

机构地区：[1]上海市浦东医院,复旦大学附属浦东医院神经外科,201399

出　　处：《国际脑血管病杂志》2019年第9期679-684,共6页International Journal of Cerebrovascular Diseases

基　　金：浦东新区卫生和计划生育委员会学科建设(PWZzk2017-16)。

摘　　要：目的比较手术夹闭与血管内弹簧圈栓塞治疗老年动脉瘤性蛛网膜下腔出血的效果。方法回顾性纳入2009年1月至2017年12月期间在上海市浦东医院接受治疗的老年(年龄>65岁)动脉瘤性蛛网膜下腔出血患者。根据治疗策略分为开颅夹闭组和血管内介入治疗组。出院时应用格拉斯哥转归量表进行短期转归评估,4~5分定义为转归良好,1~3分定义为转归不良。长期随访采用改良Rankin量表评估临床转归,0~2分定义为转归良好,3~6分定义为转归不良。对两组临床和影像学信息、围手术期并发症、短期和长期临床转归以及长期影像学转归进行比较。应用多变量logistics回归分析评估临床转归的独立影响因素。结果共纳入68例老年动脉瘤性蛛网膜下腔出血患者,其中47例(69.1%)接受血管内弹簧圈栓塞治疗,21例(30.9%)接受显微外科夹闭。两组围手术期并发症发生率、短期和长期转归不良率以及影像学复发率均无显著统计学差异。多变量logistic回归分析显示,吸烟[优势比(odds ratio,OR)36.319,95%可信区间(confidence interval,CI)3.530~373.640;P=0.003]、改良Fisher分级(OR 20.406,95%CI 2.022~205.964;P=0.011)和世界神经外科联盟分级(OR 4.686,95%CI 1.012~21.692;P=0.048)是老年动脉瘤性蛛网膜下腔出血患者短期转归不良的独立危险因素。结论血管内介入治疗和显微外科夹闭均是老年动脉瘤性蛛网膜下腔出血患者安全有效的治疗方法。Objective To compare the treatment effect of surgical clipping and endovascular coil embolization for aneurysmal subarachnoid hemorrhage(aSAH)in the elderly.Methods Elderly patients with aSAH(aged>65 years)treated in Shanghai Pudong Hospital from January 2009 to December 2017 were enrolled retrospectively.They were divided into craniotomy clipping group and endovascular intervention group according to the treatment strategy.The Glasgow Outcome Scale was used for short-term outcome assessment at discharge,4-5 were defined as good outcome,and 1-3 were defined as poor outcome.Long-term follow-up was performed to assess clinical outcomes using the modified Rankin Scale,0-2 was defined as good outcome and 3-6 were defined as poor outcome.The clinical and imaging information,perioperative complications,short-term and long-term clinical outcomes,and long-term imaging outcomes were compared between the two groups.Multivariate logistic regression analysis was used to assess the independent influencing factors of clinical outcomes.Results A total of 68 elderly patients with aSAH were enrolled.Of these,47(69.1%)received endovascular coil embolization and 21(30.9%)underwent microsurgical clipping.There were no significant differences between the two groups in the incidence of perioperative complications,short-term and long-term adverse outcomes,and imaging recurrence rate.Multivariate logistic analysis showed that smoking(odds ratio[OR]36.319,95%confidence interval[CI]3.530-373.640;P=0.003),modified Fisher grade(OR 20.406,95%CI 2.022-205.964;P=0.011)and World Federation of Neurological Societies(WFNS)grade(OR 4.686,95%CI 1.012-21.692;P=0.048)were the independent risk factors for short-term poor outcomes in elderly patients with aSAH.Conclusion Both endovascular intervention and microsurgical clipping are safe and effective treatments for elderly patients with aSAH.

关 键 词：蛛网膜下腔出血 颅内动脉瘤 动脉瘤 破裂 栓塞 治疗性 血管内手术 老年人 治疗结果 

分 类 号：R65[医药卫生—外科学]