开颅血管搭桥联合介入栓塞治疗小脑后下动脉动脉瘤疗效及对神经损伤因子和预后的影响  

Efficacy of open vascular bypass combined with interventional embolization forposterior inferior cerebellar artery aneurysm and its effect on neurological injury factors and prognosis

作　　者：王文德 王天恩[1] 张青德 高鹏 WANG Wen-de;WANG Tian-en;ZHANG Qing-de;GAO Peng(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450000

出　　处：《医药论坛杂志》2024年第8期869-872,877,共5页Journal of Medical Forum

摘　　要：目的探讨开颅血管搭桥联合介入栓塞治疗小脑后下动脉动脉瘤(posterior inferior cerebellar artery aneurysms,PICAA)疗效及对神经损伤因子、预后的影响。方法选取郑州大学第一附属医院2019年3月至2022年10月PICAA者81例,按照治疗术式不同分成联合组(41例)与栓塞组(40例)。栓塞组接受介入栓塞治疗,联合组接受开颅血管搭桥+介入栓塞治疗,统计对比两组疗效、预后、围术期指标[术中出血量、住院时长、手术时长]以及术前、术后1 d神经损伤因子[神经元特异性烯醇化酶(NSE)、星形胶质源性蛋白(S100β)]、免疫功能[CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)]、血清因子[基质金属蛋白酶-9(MMP-9)、核因子-κB(NF-κB)、细胞间黏附分子-1(ICAM-1)]。结果联合组疗效优于栓塞组,且GOS评分高于栓塞组(P<0.05);与栓塞组相比,联合组住院时长、手术时长明显延长,术中出血量明显增多(P<0.05);术后1 d联合组血清S100β、NSE水平略高于栓塞组,但两组之间无明显差异(P>0.05);术后1 d联合组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)略低于栓塞组,但差异无统计学意义(P>0.05);术后1 d联合组血清MMP-9、ICMA-1、NF-κB水平少于栓塞组(P<0.05)。结论开颅血管搭桥联合介入栓塞治疗PICAA患者效果明显,可有效保护脑神经,减轻炎症反应。Objective To investigate the efficacy of open vascular bypass+interventional embolization in the treatment of posterior inferior cerebellar artery aneurysm(PICAA)and its effect on neurological injury factors and prognosis.Methods Eighty-one patients with PICAA admitted to our hospital between March 2019 and October 2022 were selected as study subjects and divided into a combined group(41 cases)and an embolization group(40 cases)according to different treatment protocols.The embolization group received interventional embolization and the combination group received open vascular bypass and interventional embolization.The efficacy,prognosis,perioperative indicators[intraoperative bleeding,length of hospital stay,duration of surgery]and preoperative and 1 d postoperative neurological damage factors[neuron-specific enolase(NSE),astroglial-derived protein(S100β)],immune function[CD3^(+),CD4^(+),CD4^(+)/CD8^(+)],serum factors[matrix metalloproteinase-9(MMP-9),nuclear factor-κB(NF-κB),intercellular adhesion molecule-1(ICAM-1)].Results The combined group had better efficacy than the embolization group,and the GOS score was higher than that of the embolization group(P<0.05);Compared with the embolization group,the length of hospitalization and duration of surgery were significantly longer in the combined group,and intraoperative bleeding was significantly higher(P<0.05);serum S100βand NSE levels were slightly higher in the combined group than in the embolization group 1 d after surgery,but there was no significant difference between the two groups(P>0.05);1 d after surgery CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)were slightly lower in the combined group than in the embolization group,but the difference was not statistically significant(P>0.05);Serum MMP-9,ICMA-1 and NF-κB levels were lower in the combined group than in the embolization group 1 d after surgery(P<0.05).Conclusion Cranial vascular bypass combined with interventional embolization is effective in treating patients with PICAA,which can effectively protect brain n

关 键 词：开颅血管搭桥 介入栓塞 PICAA 神经损伤 

分 类 号：R651.12[医药卫生—外科学]