外科手术夹闭和血管内治疗对大脑中动脉动脉瘤的疗效对比分析:一项基于倾向性评分匹配的回顾性队列研究  

Efficacy of surgical clipping and endovascular treatment for middle cerebral artery aneurysms:a retrospective cohort study based on propensity score matching

作　　者：崔仕振 何朝晖[1] CUI Shizhen;HE Zhaohui(Department of Neurosurgery,the First Affliated Hospital of Chongqing Medical University,Chongqing,400010,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400100

出　　处：《陆军军医大学学报》2023年第16期1763-1769,共7页Journal of Army Medical University

基　　金：国家自然科学基金面上项目(81870927)。

摘　　要：目的对外科手术夹闭和血管内治疗大脑中动脉动脉瘤的临床疗效、预后、神经功能情况、手术并发症和复发率进行比较分析。方法本研究采用回顾性队列分析,收集2013-2021年在本院神经外科进行大脑中动脉动脉瘤诊治的265例患者的临床治疗数据。根据治疗方式,将患者分为外科手术夹闭组和血管内治疗组,通过单因素分析2组复发情况。基于倾向性评分匹配分析2组临床预后、神经功能结局以及手术并发症发生率。结果共计162例患者接受了外科手术夹闭治疗,103例患者接受了血管内治疗。经过倾向性评分匹配(propensity score matching,PSM)控制患者的年龄、性别、基础疾病、吸烟饮酒史、动脉瘤位置和大小及形态、是否破裂、Hunt-Hess分级、GCS评分的一致性,将103例接受外科夹闭与103例接受血管内治疗的患者进行匹配。血管内治疗的临床预后良好率(99.03%vs 86.41%,P<0.001)及神经功能恢复良好率(88.35%vs 63.11%,P<0.001)均高于外科手术夹闭组。外科手术夹闭组手术并发症发生率高于血管内治疗组,2组颅内感染占比(24.27%vs 5.83%,P<0.001)差异有统计学意义,在血管痉挛、迟发性脑梗塞、脑积水、术中破裂、癫痫方面没有显著差异。血管内治疗组的复发率高于夹闭组(3.33%vs 1.11%,P=0.560)。结论血管内治疗的临床预后及神经功能转归情况优于外科手术夹闭,且具有更少的手术并发症发生率,但是外科夹闭手术有更低的复发率。在两种手术方式都可选择的情况下,推荐优先选择血管内治疗。Objective To compare and analyze 2 therapeutic methods,the surgical dipping and endovascular treatment in the clinical efficacy,prognosis,neurological function outcomes,surgical complications and recurrence rate for middle cerebral artery aneurysm.Methods A retrospective cohort study was conducted on 265 patients receiving treatment for middle cerebral artery aneurysms in our hospital from January 2013 to December 2021.These patients were divided into surgical clipping group and endovascular treat ment group according to the therapeutic methods they chose.Univariate analysis was used to analyze the recurrence rate in these 2 groups.Clinical prognosis,neurological function outcomes and surgical complication rates of these 2 groups were analyzed based on propensity score matching.Results A total of 162 patients underwent surgical clipping and 103 patients received endovascular treatment.Propensity score matching(PSM)was used to control the baseline characteristics,and 103 patients who received surgical clipping were matched with 103 patients who received endovascular treatment.The good ci nical prognosis rate(99.03%1s 86.41%,P<0.001)and neurological function recovery rate(88.35%ns63.11%,P<0.001)of endovascular treatment were higher than those in the surgical clipping group,which were statistically significant.The clipping group had a greater rate of surgical complications than that in the interventional group,with intracranial infection(24.27%1s 5.83%,P<0.001)being the most significant.No differences were observed in vasospasm,delayed cerebral infarction,hydrocephalus,intraoperative rupture or epilepsy.The endovascular group had a higher recurrence rate than that in the surgical clipping group(3.33%us 1.11%,P=0.560).Conclusion Endovascular treatment has better clinical prognosis and neurological function outcomes and has fewer surgical complication rates than that of surgical clipping,but surgical dlipping appears to result in lower recurrence rates.Endovascular treatment is recommended when both two therapeutic me

关 键 词：大脑中动脉动脉瘤 血管内治疗 外科手术夹闭 倾向性评分匹配 

分 类 号：R195.4[医药卫生—卫生统计学] R651.12[医药卫生—卫生事业管理] R739.41[医药卫生—公共卫生与预防医学]