脑动脉瘤破裂栓塞术后远期恢复效果及复发的危险因素分析  

Long-term recovery effect and risk factors of cerebral aneurysm recurrence after embolization

作　　者：李平安 林献青 李昊 李嘉琪 郭铭 冯金福 Li Ping′an;Lin Xianqing;Li Hao;Li Jiaqi;Guo Ming;Feng Jinfu(Department of Neurosurgery,Yuebei People′s Hospital,Shantou University Medical College,Shaoguan 512026,China;the Second Clinical Medical School of Southern Medical University,Guangzhou 510515,China;the First Clinical School of Hubei University of Chinese Medicine,Wuhan 430060,China)

机构地区：[1]汕头大学医学院附属粤北人民医院神经外科,韶关512026 [2]南方医科大学第二临床医学院,广州510515 [3]湖北中医药大学第一临床学院,武汉430060

出　　处：《中国医师杂志》2025年第3期392-396,共5页Journal of Chinese Physician

基　　金：韶关市卫生健康科研项目(Y21148)。

摘　　要：目的观察远期随访脑动脉瘤破裂栓塞术后恢复效果并探讨动脉瘤复发的相关因素。方法选取2000年8月—2013年8月期间粤北人民医院收治的142例颅内动脉瘤破裂栓塞术患者为研究对象,全部经过栓塞治疗,术后进行数字减影血管造影(DSA)、CT血管造影(CTA)、磁共振血管成像(MRA),随访时间为10年,采用脑卒中改良Rankin量表(mRS)评分评价远期疗效。分析不同方法栓塞组术后即刻造影结果、远期随访结果,单因素分析脑动脉瘤破裂栓塞术后复发的危险因素,多因素分析脑动脉瘤破裂栓塞术后复发的独立危险因素。结果142例患者(161个动脉瘤)中,单纯栓塞106个,支架辅助栓塞55个。单纯栓塞与支架辅助栓塞的即刻栓塞结果相比,差异无统计学意义(P>0.05)。支架辅助栓塞组巨大动脉瘤占比高于单纯栓塞(P<0.05)。随访结果显示:142例患者mRS评分0分的为106例,1分的为27例,2分的为5例,4分的为4例,临床预后良好率为93.7%(133/142)。随访的161个动脉瘤中,复发36个,复发率为22.4%(36/161)。单因素分析结果显示,动脉瘤大小、颈瘤、术后栓塞程度是脑动脉瘤复发的危险因素(均P<0.05);多因素分析结果显示,动脉瘤大小是脑动脉瘤复发的独立危险因素(P<0.05)。结论脑动脉瘤栓塞术后远期随访效果较好,但脑动脉瘤仍有复发可能。动脉瘤大小是影响动脉瘤复发的独立危险因素,及时发现脑血管变化可以及时治疗,避免脑血管意外的发生。ObjectiveTo observe the effect of long-term follow-up of cerebral aneurysm embolization and to explore the related factors of aneurysm recurrence.MethodsA total of 142 cases of intracranial aneurysm rupture embolization patients treated in the Yuebei People′s Hospital from August 2000 to August 2013 were selected as the study objects.All of them underwent embolization treatment,and digital subtraction angiography(DSA),CT angiography(CTA)and magnetic resonance angiography(MRA)were performed after surgery.The follow-up period was 10 years,and the long-term outcome was evaluated using the Stroke Modified Rankin Scale(mRS)score.The results of immediate postoperative angiography and long-term follow-up in different embolization groups were analyzed.The risk factors of recurrence after ruptured cerebral aneurysm embolization were analyzed by single factor and independent risk factors were analyzed by multiple factor.ResultsOf 142 patients(161 aneurysms),106 were embolized by simple embolization and 55 were embolized by stent-assisted embolization.There was no significant difference in the results of immediate embolization between simple embolization and stent assisted embolization(P>0.05).The proportion of giant aneurysms in the stent-assisted embolization group was higher than that in the simple embolization group(P<0.05).Follow-up results showed that among the 142 patients,106 had mRS score 0,27 had mRS score 1,5 had mRS score 2,and 4 had mRS score 4.The good clinical prognosis rate was 93.7%(133/142).Of the 161 aneurysms,36 recurred,with a recurrence rate of 22.4%(36/161).Univariate analysis showed that aneurysm size,cervical tumor and embolization degree were risk factors for cerebral aneurysm recurrence(all P<0.05).The results of multi-factor analysis showed that aneurysm size was an independent risk factor for cerebral aneurysm recurrence(P<0.05).ConclusionsThe long-term follow-up after embolization of cerebral aneurysms is good,but cerebral aneurysms still have the possibility of recurrence.Aneurysm size is an

关 键 词：颅内动脉瘤 动脉瘤 破裂 栓塞 治疗性 复发 

分 类 号：R743.4[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]