颈内动脉眼动脉段侧壁动脉瘤的形态学特征分析  

Morphological analysis of sidewall ophthalmic segment aneurysms of internal carotid artery

作　　者：翟晓东[1] 李传捷[1] 何川[1] 胡鹏[1] 张鸿祺[1] Zhai Xiaodong;Li Chuanjie;He Chuan;Hu Peng;Zhang Hongqi(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2021年第10期672-678,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究重点专项资助项目(2016YFC1300800);北京市医院管理局“登峰”人才培养计划项目(DFL20180801)。

摘　　要：目的探讨颈内动脉眼动脉段侧壁动脉瘤的形态学特征及其与破裂风险间的关系。方法回顾性连续纳入首都医科大学宣武医院神经外科颅内动脉瘤患者数据库中的病历资料,数据库资料收集时间为2012年7月至2014年12月,治疗前均经三维全脑DSA确诊。最终连续纳入191例前循环侧壁颅内动脉瘤患者,共214个颅内动脉瘤,其中172例为单发动脉瘤,15例患者有2个动脉瘤,4例患者有3个动脉瘤。比较不同部位动脉瘤的破裂率。在分析眼动脉段动脉瘤的基线特征及形态学特征时,分为破裂组和未破裂组进行比较,基线特征(性别、年龄、高血压病)以患者例数进行统计,对于有破裂动脉瘤者计为破裂组;形态学特征以动脉瘤个数进行统计。在进行动脉瘤形态学特征(动脉瘤的最大径、高度、宽度、纵横比、尺寸比、长宽比,瘤颈宽度,载瘤动脉直径,入射角度)比较时,分为眼动脉段组、后交通动脉段组和前循环其他部位(颈内动脉非眼动脉段、大脑中动脉段、大脑前动脉段)组,以动脉瘤个数进行统计。采用Bonferroni法进行多重比较校正,P<0.0167(0.05/3)被认为差异具有统计学意义。结果(1)214个前循环侧壁颅内动脉瘤中,位于颈内动脉眼动脉段101个(47.2%),后交通动脉段74个(34.6%),颈内动脉非眼动脉段19个(8.9%),大脑中动脉段7个(3.3%),大脑前动脉段13个(6.1%)。前循环侧壁动脉瘤总破裂率为32.7%(70/214),不同部位破裂占比由低至高分别为眼动脉段动脉瘤[破裂率为13.9%(14/101)]、大脑中动脉段动脉瘤(破裂占比为1/7)、后交通动脉段动脉瘤[破裂率为50.0%(37/74)]、颈内动脉非眼动脉段动脉瘤(破裂占比为10/19)、大脑前动脉段动脉瘤(破裂占比为8/13)。(2)眼动脉段破裂组和未破裂组患者分别为14、74例,眼动脉段破裂组和未破裂组动脉瘤数分别为14、87个,两组基线特征、形态学特征的差异均无统计学意义(均P>0.0Objective To analyze the morphological characteristics of the sidewall aneurysm of the ophthalmic segment and explore the relationship between the morphological characteristics and risk of rupture.Methods The medical records in the database of patients with intracranial aneurysms admitted to the Department of Neurosurgery of Xuanwu Hospital,Capital Medical University from July 2012 to December 2014 were retrospectively analyzed.All patients were diagnosed by three-dimensional DSA before treatment.A total of 191 patients with anterior circulation sidewall aneurysms were successively included,including 214 intracranial aneurysms.Among them,172 patients had single aneurysm,15 patients had 2 aneurysms,4 patients had 3 aneurysms.Compare the rupture rate among different aneurysm locations.When analyzing the baseline and morphological characteristics of the ophthalmic segment aneurysm,patients were divided into the ruptured group and the unruptured group.The baseline characteristics(sex,age,hypertension)were analyzed by the number of patients,and the patients with ruptured aneurysm were classified as the ruptured group.Morphological characteristics were calculated by the number of aneurysms.When comparing the aneurysm morphological characteristics(maximum diameter,height,width,aspect ratio,size ratio,length-width ratio,neck width,parent artery diameter,inflow angle),they were divided into ophthalmic segment group,posterior communicating artery segment group and other parts of anterior circulation group(non-ophthalmic segment of internal carotid artery,middle cerebral artery segment and anterior cerebral artery segment).Bonferroni correction was used and P-value<0.0167(0.05/3)were considered statistically significant.Results(1)Among the 214 anterior circulation sidewall aneurysms,101(47.2%)located at ophthalmic segment,74(34.6%)located at posterior communicating artery segment,19(8.9%)located at non-ophthalmic segment of internal carotid artery,7(3.3%)of middle cerebral artery and 13(6.1%)of the anterior cerebral artery.

关 键 词：颅内动脉瘤 动脉瘤 破裂 眼动脉段动脉瘤 形态学特征 破裂风险 

分 类 号：R743.4[医药卫生—神经病学与精神病学]