支架联合弹簧圈在颅内破裂动脉瘤治疗中应用研究  

Study on the application of stent combined with spring coil in intracranial ruptured aneurysms

作　　者：朱春伟 罗轶 郑聪颖[2] 陈圣攀 舒航[2] 谢强 Zhu Chunwei;Luo Yi;Zheng Congying;Chen Shengpan;Shu Hang;Xie Qiang(Department of Neurosurgery,Guangdong Provincial People’s Hospital Zhuhai Hospital(Zhuhai Golden Central Hospital),Zhuhai 519090,China;Department of Neurosurgery,Guangdong Provincial People’s Hospital,Guangzhou 510000,China)

机构地区：[1]广东省人民医院珠海医院(珠海市金湾中心医院)神经外科,珠海519090 [2]广东省人民医院神经外科,广州510000

出　　处：《中华实验外科杂志》2023年第11期2339-2342,共4页Chinese Journal of Experimental Surgery

基　　金：2021年广东省医学科研基金(B2021120)。

摘　　要：目的:探讨支架与弹簧圈联合在颅内破裂动脉瘤患者中应用价值。方法:收集2020年9月至2022年9月广东省人民医院珠海医院(珠海市金湾中心医院)和广东省人民医院122例颅内破裂动脉瘤患者临床资料,根据手术方案分为对照组(61例)和研究组(61例),对照组行单纯弹簧圈栓塞术,研究组行支架与弹簧圈联合栓塞术。统计两组栓塞程度分级、并发症、预后,对比手术前后脑灌注指标[脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)]、血管内皮功能指标[血管性假性血友病因子(vWF)、血管内皮生长因子(VEGF)、一氧化氮合酶(NOS)]。计数资料间比较采用χ^(2)检验,等级资料采用Ridit检验,计量资料间比较采用t检验,多个时间点计量资料间比较采用重复测量方差分析。结果:研究组栓塞程度优于对照组(u=1.918,P<0.05);术后12 h研究组CBV(1.83±0.04)ml/min、CBF(31.03±2.89)ml/min低于对照组(1.89±0.12)ml/min、(34.46±2.74)ml/min,MTT(4.48±0.48)s高于对照组(4.20±0.44)s(t=3.705、6.727、3.358,P<0.05);两组血清vWF[(117.89±13.34)ng/ml比(115.68±15.72)ng/ml、(90.88±8.86)ng/ml比(102.23±10.11)ng/ml、(65.85±5.63)ng/ml比(81.12±7.37)ng/ml]、VEGF[(524.41±26.68)pg/ml比(522.36±28.13)pg/ml、(332.28±21.12)pg/ml比(417.75±23.38)pg/ml、(257.72±19.56)pg/ml比(369.95±21.23)pg/ml]、NOS[(83.60±7.57)IU/ml比(81.95±8.85)IU/ml、(56.52±6.63)IU/ml比(67.73±7.18)IU/ml、(40.43±5.51)IU/ml比(54.52±5.67)IU/ml]水平组间、时间点、组间·时间点比较,差异有统计学意义(F组间=22.411、28.333、12.833,F时间点=22.951、51.692、26.991,F组间·时间点=22.533、33.886、20.232,P<0.05);两组并发症发生率比较,差异无统计学意义(χ^(2)=0.606,P>0.05);术后6个月,研究组预后优良率86.88%高于对照组(72.13%,χ^(2)=4.075,P<0.05)。结论:支架联合弹簧圈可改善颅内破裂动脉瘤患者栓塞程度,减轻血管内皮损伤程度,且对脑灌注影响较小。Objective To investigate the application value of the combination of stent and coil in patients with intracranial ruptured aneurysm.Methods Collect clinical data of 122 patients with intracranial ruptured aneurysms in Guangdong Provincial People’s Hospital Zhuhai Hospital(Zhuhai Golden Central Hospital)and Guangdong Provincial People’s Hospital from September 2020 to September 2022,and they were divided into a control group(n=61)and a study group(n=61)according to the surgical plan.The group underwent simple coil embolization,and the study group underwent combined stent and coil embolization.Calculate the degree of embolism grading,complications,and prognosis of two groups,and compare the cerebral perfusion indicators[cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)]and vascular endothelial function indicators[von willebrand factor(vWF),vascular endothelial growth factor(VEGF),nitric oxide synthase(NOS)]before and after surgery.comparison between counting data usingχ^(2)-test,Ridit test is used for hierarchical data,t-test is used for comparison between measurement data,and repeated measurement analysis of variance is used for comparison between measurement data at multiple time points.Results The degree of embolization in the study group was better than that in the control group(u=1.918,P<0.05);At 12 hours after surgery,the CBV(1.83±0.04)ml/min and CBF(31.03±2.89)ml/min in the study group were lower than those in the control group(1.89±0.12)ml/min and(34.46±2.74)ml/min,while the MTT(4.48±0.48)s was higher than that in the control group(4.20±0.44)s(t=3.705,6.727,3.358,P<0.05);The serum vWF[(117.89±13.34)ng/ml vs.(115.68±15.72)ng/ml,(90.88±8.86)ng/ml vs.(102.23±10.11)ng/ml,(65.85±5.63)ng/ml vs.(81.12±7.37)ng/ml],VEGF[(524.41±26.68)pg/ml vs.(522.36±28.13)pg/ml,(332.28±21.12)pg/ml vs.(417.75±23.38)pg/ml,(257.72±19.56)pg/ml vs.(369.95±21.23)pg/ml],and NOS[(83.60±7.57)IU/ml vs.(81.95±8.85)IU/ml,(56.52±6.63)IU/ml vs.(67.73±7.18)IU/ml,(40.43±5.51)IU/ml vs.(54.52±5.6

关 键 词：颅内破裂动脉瘤 弹簧圈 支架 脑灌注 血管性假性血友病因子 一氧化氮合酶 

分 类 号：R651.12[医药卫生—外科学]