血流导向装置治疗颅内未破裂动脉瘤的疗效与影响因素分析  

Flow-diverters in treating unruptured intracranial aneurysms:a study of efficacy and influencing factors

作　　者：连万成 姚京 吴泽涛 何毅[3] 伍健明[3] 张猛[3] Wancheng Lian;Jing Yao;Zetao Wu;Yi He;Jianming Wu;Meng Zhang(Shenzhen Second People's Hospital Clinical College,Anhui Medical University,Hefei 230032,China;Department of Neurosurgery,South China Hospital of Shenzhen University,Shenzhen 518116,China;Department of Neurosurgery,the First Affiliated Hospital of Shenzhen University,Shenzhen 518035,China)

机构地区：[1]安徽医科大学深圳二院临床学院,合肥230032 [2]深圳大学附属华南医院神经外科,518116 [3]深圳大学第一附属医院神经外科,518035

出　　处：《中华脑血管病杂志（电子版）》2023年第1期31-36,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：深圳市2020年基础研究重点项目(基2020N325)。

摘　　要：目的探讨单纯血流导向装置或联合弹簧圈治疗颅内未破裂动脉瘤的短中期疗效以及影响因素。方法回顾性连续纳入深圳大学第一附属医院血管神经外科2019年1月至2020年12月采用Tubridge血流导向装置治疗的未破裂颅内动脉瘤患者手术数据及3~18个月随访数据。有完整随访资料者共46例(均以最后1次随访数据为准),分析病例的临床资料、手术结果(闭塞率)、动脉瘤形态学特征情况。采用单因素结合多因素非条件Logistic回归分析方法,分析动脉瘤闭塞率的影响因素。结果46例患者根据随访结果分为完全闭塞组(28例)与不完全闭塞组(18例)。2组患者年龄、动脉瘤类型、有无侧支方面比较差异均无统计学意义(P均>0.05)。单纯使用Tubridge血流导向装置(密网支架)栓塞治疗者32例,辅助弹簧圈治疗者14例,手术成功率100%。在3~18个月术后影像学随访过程中,在完全闭塞组密网支架联合弹簧圈治疗者占12/28,而未完全闭塞组密网支架联合弹簧圈治疗者仅占2/18,2组比较差异具有统计学意义(χ^(2)=4.792,P=0.029)。进一步对照分析发现动脉瘤有无侧支发出、是否联合弹簧圈治疗、随访时间>6个月是影响动脉瘤闭塞的主要因素(OR=0.101、9.832、9.266,P=0.003、0.009、0.021)。结论血流导向装置治疗颅内未破裂动脉瘤在>6个月的时间随访时有着良好的闭塞率,且联合弹簧圈辅助治疗时闭塞率更高,但动脉瘤存在侧支血管会影响其闭塞率。Objective To explore the short and medium-term efficacy and influencing factors of simple flow diverter stents(FD)or combined with coil embolization in treating unruptured intracranial aneurysms.Methods The clinical data and 3-18 months of follow-up data of patients were collected and analyzed,who were treated with Tubridge(TB,Microport,Shanghai,CN)for intracranial aneurysm at the First Affiliated Hospital of Shenzhen University from January 2019 to December 2020.The clinical data,surgical outcomes(occlusion rate),and morphological characteristics of aneurysms were analyzed.For the above data,the influencing factors of occlusion rate were analyzed by univariate combined with multivariate unconditional logistic regression analysis.Results A total of 46 cases with complete data were included in the study.According to the follow-up results,they were divided into the completed occlusion group(n=28)and the incomplete occlusion group(n=18).There were no statistically significant differences in ages of onset,aneurysm types,with or without collateral vessels(all P>0.05).Among all patients,32 patients were embolized with blood flow guidance device alone and the other 14 patients were assisted with coil embolization.The success rate of the operation was 100%.During postoperative imaging follow-up for 3-18 months,treatment with FD combined with coil embolization accounted for 12/28 in the completed occlusion group,and accounted for 2/18 in the incomplete occlusion group,showing a significantly statistical difference(χ^(2)=4.792,P=0.029).Further comparative analysis showed that the presence or absence of collateral branches,with or without coil embolization,and follow-up time>6 months were the major factors affecting the primary closure of aneurysms(OR=0.101,9.832,9.266;P=0.003,0.009,0.021).Conclusion The occlusion rate of unruptured intracranial aneurysms treated with FDs was reasonable during the follow-up of more than 6 months,and the occlusion rate is higher when combined with coil embolization;however,the occlusion rat

关 键 词：颅内动脉瘤 血流导向装置 弹簧圈 侧支供血 介入治疗 

分 类 号：R651.1[医药卫生—外科学]