前循环血泡样动脉瘤显微手术和血管内介入治疗的对比分析  

Microsurgery and endovascular interventional therapy for anterior circulatory blood blister-like aneurysms

作　　者：谭海斌[1] 张天[1] 黄光富[1] 李志立 王振宇 程美雄[1] 刘泠 刘灵童 胡晓[1] 胡俊亭 Tan Haibin;Zhang Tian;Huang Guangfu;Li Zhili;Wang Zhenyu;Cheng Meixiong;Liu Ling;Liu Lingtong;Hu Xiao;Hu Junting(Department of Neurosurgery,Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital,Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院神经外科,成都610072

出　　处：《中华脑科疾病与康复杂志（电子版）》2020年第2期75-81,共7页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的总结血泡样动脉瘤(BBA)的临床特点及探讨其治疗策略,比较开颅手术治疗与血管内治疗的有效性和安全性。方法回顾性分析四川省医学科学院·四川省人民医院神经外科自2009年9月至2019年8月收治的68例BBA患者的临床资料,按照治疗方法分为开颅手术治疗组和血管内治疗组。开颅手术治疗组:27例患者行开颅手术治疗,分别采用夹闭、包裹及孤立等方式。血管内治疗组:41例患者行血管内治疗,分别采用单或多支架、密网支架辅助弹簧圈栓塞等方法。比较2组患者的围手术期并发症发生情况与临床预后,出院时预后评估采用改良Rankin量表(mRs)评分。结果开颅手术治疗组:直接夹闭22例,包裹夹闭4例,孤立+搭桥1例;术中破裂出血18例,术后脑梗死21例,术后再次出血补救治疗7例,术后血液高凝状态19例;出院时mRs评分0~2分8例,3~5分10例,6分(死亡)9例。血管内治疗组:单或多支架辅助弹簧圈栓塞术32例,血流导向装置9例;术中破裂出血17例,术后脑梗死22例,术后再次出血补救治疗5例,去骨瓣减压11例,术后血液高凝状态26例;出院时mRs评分0~2分30例,3~5分6例,6分(死亡)5例。随访6~84个月,开颅手术治疗组存活18例,失访2例,复发3例;血管内治疗组存活36例,失访3例,复发3例。结论重建和加固载瘤动脉壁是治疗BBA的关键。围手术期监测凝血功能对及时处理高凝状态、防治脑血管痉挛、降低严重脑梗死发生率极为重要。相对于外科手术方法,血管内治疗似乎能带来更低的复发率、死亡率和更好的预后结果。Objective To summarize the clinical characteristics and explore the treatment strategies of blood blister-like aneurysms(BBAs),and compare the efficacy and safety of craniotomy for BBAs and endovascular treatment.Methods The clinical data of 68 patients with BBA admitted to the Department of Neurosurgery of Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital from September 2009 to August 2019 were retrospectively analyzed.Craniotomy group:27 patients were treated with craniotomy,including clipping,wrapping and isolation.Endovascular treatment group:41 patients were treated with endovascular treatment,using single or multiple stents,dense mesh stent assisted coil embolization and other methods.The perioperative complications and clinical prognosis of the two groups were compared.The modified Rankin scale(mRs)score was used to evaluate the prognosis at discharge.Results In the craniotomy group,22 patients were directly clipped,4 patients were wrapped,1 patient was isolated+bypass.There were 18 patients of intraoperative rupture hemorrhage,21 patients of postoperative cerebral infarction,7 patients of postoperative rebleeding,and 19 patients of postoperative hypercoagulability.At the time of discharge,the mRs score was 0-2 in 8 patients,3-5 in 10 patients and 6 in 9 patients(death).In the endovascular treatment group,32 patients were treated with single or multiple stent-assisted coil embolization,and 9 patients were treated with flow guiding device.There were 17 patients of intraoperative hemorrhage,22 cases of postoperative cerebral infarction,5 patients of postoperative rebleeding,11 patients of decompressivecraniectomy and 26 patients of postoperative hypercoagulability.At the time of discharge,the mRs score was 0-2 in 30 patients,3-5 in 6 patients and 6 in 5 patients(death).The follow-up time was 6-84 months.In the craniotomy group,18 patients survived,2 patients were lost to follow-up,and 3 patients were recurrent.In the intravascular treatment group,34 patients survived,3 patients were

关 键 词：血泡样动脉瘤 动脉瘤夹闭 血管内介入 血流重建 

分 类 号：R743.4[医药卫生—神经病学与精神病学]