支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的安全性和有效性观察  

Safety and effectiveness of stent-assisted coil embolization in treatment of acute intracranial rupture wide-necked aneurysms

作　　者：蒙宏亮 李振均 曾恒 段传志[1] 李西锋[1] 张炘[1] 何旭英[1] Meng Hongliang;Li Zhenjun;Zeng Heng;Duan Chuanzhi;Li Xifeng;Zhang Xin;He Xuying(Department of Neurosurgery,Zhujiang Hospital of Southern Medical University,National Key Clinical Specialty,Engineering Technology Research Center of Ministry of Education,Guangdong Institute of Neurosurgery,Guangdong Key Laboratory of Brain Function Repair and Regeneration,Guangzhou 520282,China)

机构地区：[1]南方医科大学珠江医院神经外科,国家临床重点专科,教育部工程技术研究中心,广东神经外科研究所,广东省脑功能修复与再生重点实验室,广州510282

出　　处：《中华神经医学杂志》2021年第6期584-589,共6页Chinese Journal of Neuromedicine

基　　金：国家重点研发计划(2016YFC1300804、2016YFC1300800)。

摘　　要：目的探讨支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤的安全性和有效性。方法将南方医科大学珠江医院神经外科自2014年1月至2018年12月应用支架辅助弹簧圈栓塞治疗的249例急性期颅内宽颈动脉瘤患者(共301个动脉瘤),依据是否发生动脉瘤破裂将患者分为破裂组(114例)与未破裂组(135例)。回顾性分析2组患者间预后[采用改良Rankin量表(mRS)评分评估]以及围手术期并发症发生率、死亡率、动脉瘤复发率的差异,并采用单因素分析及多因素Logistic回归分析筛选影响破裂组患者围手术期并发症发生及动脉瘤复发的危险因素。结果破裂组患者中围手术期并发症发生率(10.5%)略高于未破裂组(6.6%),未破裂组患者中动脉瘤复发率(12.8%)略高于破裂组(9.6%),但差异均无统计学意义(P>0.05);除破裂组2例患者因术后再出血死亡外,2组其余患者的预后均良好(mRS评分≤3分)。单因素分析显示,破裂组患者中发生并发症组与未发生并发症组间年龄分布差异有统计学意义(P<0.05),动脉瘤复发组与动脉瘤未复发组间动脉瘤大小及栓塞程度的差异有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄40~60岁为影响患者围手术期并发症发生的独立危险因素(OR=17.819,95%CI:2.356~137.719,P=0.005),动脉瘤直径>10 mm及动脉瘤Raymond 3级栓塞为影响患者动脉瘤复发的独立危险因素(OR=36.823,95%CI:0.862~768.308,P=0.000;OR=52.813,95%CI:2.967~938.152,P=0.007)。结论支架辅助弹簧圈栓塞治疗急性期颅内破裂宽颈动脉瘤安全有效,但对于40~60岁患者应警惕其围手术期并发症的高发性,对于大动脉瘤及栓塞不完全患者应警惕其动脉瘤复发的高风险。Objective To evaluate the safety and effectiveness of stent-assisted coil embolization in treatment of acute intracranial rupture wide-necked aneurysms.Methods A total of 249 patients with acute intracranial wide-necked aneurysms(301 aneurysms)treated with stent-assisted coil embolization in our hospital from January 2014 to December 2018 were chosen in our study;these patients were divided into ruptured group(n=114)and non-ruptured group(n=135).The differences in the prognoses(modified Rankin scale[mRS]scores)and perioperative complications,mortality,and aneurysm recurrence rate were retrospectively analyzed.Univariate analysis and multivariate Logistic regression analysis were used to screen the risk factors for perioperative complications and recurrence of aneurysms in patients from the ruptured group.Results The incidence of perioperative complications in the ruptured group(10.5%)was slightly higher than that in the un-ruptured group(6.6%),and the recurrence rate of aneurysms in the un-ruptured group(12.8%)was slightly higher than that in the ruptured group(9.6%),but the differences were not statistically significant(P>0.05);except for 2 patients in the ruptured group who died of postoperative recurrent hemorrhage,the prognosis of the rest patients in the 2 groups was good(mRS scores≤3).Univariate analysis showed that there was significant difference in the age distribution between the complication group and the non-complication group in the ruptured patients(P<0.05),and the sizes and degrees of embolization between the ruptured group and un-ruptured group showed significant differences(P<0.05).Multivariate Logistic regression analysis showed that ages at 40-60 years was independent risk factor for perioperative complication(OR=17.819,95%CI:2.356-137.719,P=0.005),and aneurysm diameter>10 mm and aneurysm Raymond grading 3 embolization were independent risk factors for aneurysm recurrence(OR=36.823,95%CI:0.862-768.308,P=0.000;OR=52.813,95%CI:2.967-938.152,P=0.007).Conclusion Stent-assisted coil embolization i

关 键 词：颅内动脉瘤 破裂 宽颈 支架 弹簧圈栓塞 

分 类 号：R743.3[医药卫生—神经病学与精神病学]