显微手术夹闭与血管内治疗破裂颅内动脉瘤的疗效分析  

Analysis of the effect of microsurgical clipping and endovascular treatment of ruptured intracranial aneurysms

作　　者：刘峥 黄银兴 魏梁锋 陈其钻 王守森 洪景芳 金清东 蔡智基 黄生炫[4] Liu Zheng;Huang Yinxing;Wei Liangfeng;Chen Qizuan;Wang Shousen;Hong Jingfang;Jin Qingdong;Cai Zhiji;Huang Shengxuan(Hospital of Joint Support Force of the Chinese PLA,Fuzhou 350025,China;Department of Neurosurgery,the First Hospital of Putian City,Putian 351100,China;Department of Neurosurgery,Ningde Municipal Hospital of Ningde Normal University,Ningde 352000,China;Department of Neurosurgery,Sanming First Hospital Affiliated to Fujian Medical University Affiliated to Fujian Medical University,Sanming 365000,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇〇医院神经外科,福州350025 [2]莆田市第一医院神经外科,福建351100 [3]宁德师范学院附属宁德市医院神经外科,福建352000 [4]福建医科大学附属三明市第一医院神经外科,福建365000

出　　处：《中华神经外科杂志》2021年第8期805-809,共5页Chinese Journal of Neurosurgery

摘　　要：目的对比观察显微手术夹闭与血管内栓塞治疗破裂颅内动脉瘤的疗效。方法2000年1月至2020年10月中国人民解放军联勤保障部队第九〇〇医院等4家医院神经外科采用手术治疗的破裂颅内动脉瘤患者3724例,其中采用开颅手术夹闭动脉瘤2417例,采用血管内栓塞动脉瘤1307例。采用1∶1倾向性评分匹配法筛选血管内栓塞组和开颅手术组各415例,回顾性比较两组患者的术中和术后并发症、随访疗效及动脉瘤复发率。结果开颅手术组术中动脉瘤破裂率为22.9%(95/415),高于血管内治疗组的17.3%(72/415)(P=0.046)。术后并发症方面除了继发慢性脑积水发生率两组差异无统计学意义外(P>0.05),肺部感染、切口愈合不良、颅内感染及新发脑梗死发生率均为开颅手术组高于血管内治疗组(均P<0.05)。开颅手术组和血管内治疗组术后中位随访时间分别为30.0个月和33.0个月。末次随访显示,开颅手术组和血管内治疗组术后动脉瘤复发率分别为0.7%(3/415)和2.9%(12/415),差异有统计学意义(P<0.05);格拉斯哥预后评级结果显示血管内治疗组预后好于开颅手术组(P<0.05)。结论采用血管内栓塞治疗破裂颅内动脉瘤的并发症发生率、疗效均优于显微手术夹闭,但动脉瘤复发率相对较高。Objective To observe the effect of microsurgical clipping and endovascular embolization in the treatment of ruptured intracranial aneurysms.Methods From January 2000 to October 2020,3,724 patients with ruptured intracranial aneurysms were treated by Neurosurgery Department at 4 hospitals including the 900th Hospital of Joint Support Force of the Chinese PLA.Among them,craniotomy and microsurgical clipping were performed in 2417 cases of aneurysms,and 1307 cases of aneurysms were embolized by endovascular treatment.The 1∶1 propensity score matching method was used select 415 cases in each of the endovascular embolization group and the craniotomy group,and the intraoperative and postoperative complications,follow-up efficacy and aneurysm recurrence rate of the two groups were rostrospetiely compared.Results The intraoperative aneurysm rupture rate in the craniotomy group was 22.9%(95/415),which was higher than 17.3%(72/415)in the endovascular treatment group(P=0.046).Except for the incidence of secondary chronic hydrocephalus,there was no statistically significant difference in postoperative complications between the two groups(P>0.05).The incidences of pulmonary infection,poor incision healing,intracranial infection and newly-developed cerebral infarction were all higher in the craniotomy group than the endovascular treatment group(all P<0.05).The median postoperative follow-up time of craniotomy group and endovascular treatment group was 30.0 months and 33.0 months,respectively.The last follow-up showed that the postoperative recurrence rates of the craniotomy group and endovascular treatment group were 0.7%(3/415)and 2.9%(12/415),respectively,and the difference was statistically significant(P<0.05).The results of the Glasgow outcome score showed that the outcome of the endovascular treatment group was better than that of the craniotomy group(P<0.05).Conclusion The complication rate and therapeutic effect of endovascular embolization for the treatment of ruptured intracranial aneurysms are better than those of

关 键 词：颅内动脉瘤 破裂 神经外科手术 血管内手术 治疗结果 

分 类 号：R651.12[医药卫生—外科学]