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手术夹闭和血管内介入治疗颅内破裂动脉瘤的疗效分析 被引量:23

Outcomes of surgical versus endovascular treatment for ruptured cerebral aneurysms
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摘要 目的对手术夹闭和血管内介入治疗颅内破裂动脉瘤的疗效作初步分析。方法2004年6月至2006年6月共治疗符合入选标准的113例颅内动脉瘤病人。手术夹闭61例病人共62个动脉瘤,血管内介入栓塞52例病人共54个动脉瘤。病人术前状态采用Hunt-Hess分级,颅脑CT采用Fisher分级,术后1个月和6个月行改良Rankin评分。全部数据采用Wilcoxon秩和检验。结果手术夹闭组术前Hunt-HessⅠ~Ⅲ级53例,39例预后好,Ⅳ~Ⅴ级8例,3例预后好;术前CT Fisher分级Ⅰ~Ⅱ级35例,30例预后好,Ⅲ~Ⅳ级26例,13例预后好,术前Hunt-Hess分级和CT Fisher分级与mRS评分呈正相关。介入栓塞组术前Hunt-HessⅠ~Ⅲ级42例,33例顶后好,Ⅳ~Ⅴ级10例,2例预后好;术前CT Fisher分级Ⅰ~Ⅱ级37例,32例预后好,Ⅲ~Ⅳ级15例,7例预后好,术前Hunt-Hess分级和CT Fisher分级与mRS评分呈正相关。同一术前Hunt-Hess分级及CT Fisher分级在手术组和介入组病人中mRS评分差异无统计学意义。结论对于手术夹闭和血管内介入均适合的动脉瘤,处于同一术前Hunt-Hess分级或CT Fisher分级的病人,不论手术夹闭还是介入治疗,术后短期疗效差异无统计学意义。对于高龄、术前Hunt-Hess分级差的病人首选介入治疗。两种治疗办法的长期疗效对比仍有待于研究。 Objectives To compare the effects of neurosurgical clipping versus endovascular coiling in patients with aneurysmal subarachnoid hamorrhage in a single center. Methods Patients and aneurysm characteristics, procedural complications and clinical results were compared retrospectively in 61 patients treated by clipping and 52 by coiling. Modified Rankin Scale (mRS) was assessed at 1 and 6 months after treatment. All the data were analyzed by using Ridit-test, figures were made with SPSS 12.0. Results In the surgical groups, the number of patients with good outcome was 39 (53 with Hunt-Hess Ⅰ - Ⅱ ) , 3 (8 with Hunt-Hess Ⅳ- Ⅴ), 30 (35 with CT fisher Ⅰ - Ⅱ), 13 (26 with CT fisher Ⅲ - Ⅳ). In the endovascular treatment groups, the number of patients with good outcome was 33 (42 with Hunt-Hess Ⅰ - Ⅱ), 2 (10with Hunt-Hess Ⅳ- Ⅴ), 32 (37 with CT fisher Ⅰ -Ⅲ), 7 (15 with CTfisher Ⅲ -Ⅳ). Hunt-Hess grade and CT fisher grade were associated with mRS positively ( P 〈 0. 0001 , P = 0. 0002 ). Modified Rankin Scale in the surgical and endovascular treatment groups, who were in the same grade of Hunt-Hess and CT fisher, did not differ significantly ( P 〉 0.05 ). Conclusions If the aneurysm is considered suitable for both surgical clipping and endovascular treatment, coiling is associated with a better outcome. Endovascular treatment has changed the management of poor-grade SAH in elderly patients, most of whom are high-risk surgical candidates. The long-term effect of surgical clipping and endovascular treatment need further investigation.
出处 《中华神经外科杂志》 CSCD 北大核心 2007年第11期840-843,共4页 Chinese Journal of Neurosurgery
关键词 颅内动脉瘤 破裂 手术夹闭 栓塞 血管内介入治疗 Intracranial aneurysm, rapture Surgical clipping Embolism Endovascular treatment
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参考文献14

  • 1Molyneux A, Kerr R, Stratton I, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomised trial. Lancet, 2002, 360 : 1267-1274.
  • 2吴中学.合理选择脑血管病的治疗方法[J].中华神经外科杂志,2006,22(8):453-453. 被引量:28
  • 3魏学忠,梁国标,冯思哲,李志清,于春泳.脑动脉瘤夹闭术与栓塞术:竞争还是互补?[J].中华神经外科杂志,2006,22(8):454-456. 被引量:20
  • 4Lanzino G, Fraser K, Kanaan Y, et al. Treatment of ruptured intracranial aneurysms since the International Subarachnoid Aneurysm Trial: practice utilizing clip ligation and coil embolization as individual or complementary therapies. J Neurusurg, 2006 , 104: 344-349.
  • 5马建军,董克辛,梁国标,张商商,刘永明,罗伟环,马忠华.老年性颅内动脉瘤血管内治疗的初步体会[J].中华神经外科杂志,2006,22(7):451-451. 被引量:2
  • 6Le Roux PD, Elliott JP, Newell DW, et al. Predicting outcome in poor-grade patients with subarachnoid hemorrhage. J Neurosurg, 1996, 85:39 -49.
  • 7Sheehan JP, Polin RS, Sheehan JM, et al. Factors associated with hydrocephalus after aneurismal subarachnoid hemorrhage. Neurosurgery, 1999, 45 : 1120-1128.
  • 8刘隆熙,石岭,江澄川,冷冰,赵经郊,刘永吉.急诊夹闭与栓塞治疗颅内破裂动脉瘤的疗效初析[J].中国临床神经科学,2005,13(3):283-285. 被引量:1
  • 9Doerflera A, Wankea I, Egelhofa T, et al. Aneurysmal rupture during embolization with Guglielmi detachable coils: causes, management, and outcome. AJNR,2001, 22 : 1825-1832.
  • 10黄昌仁,陈礼刚,董劲虎,刘亮,刘洛同.微弹簧圈急诊栓塞颅内破裂动脉瘤25例[J].中华神经科杂志,2006,39(6):404-405. 被引量:2

二级参考文献42

  • 1沈建康,赵卫国,林东,胡锦清,成侃,卞留贯,孙青芳.未破裂颅内动脉瘤的治疗[J].中华神经外科杂志,2005,21(4):232-235. 被引量:14
  • 2隋大立,王硕,赵继宗.动静脉畸形合并颅内动脉瘤的治疗[J].中华神经外科杂志,2005,21(8):478-480. 被引量:11
  • 3王义宝,欧绍武,刘云会,王运杰,张久伟.颅内后循环动脉瘤的诊断与治疗(附19例报告)[J].中华神经外科杂志,2005,21(11):656-658. 被引量:22
  • 4脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381-383. 被引量:15755
  • 5王忠诚 赵继宗 等.不同部位颅内动脉瘤.神经外科学(第1版)[M].湖北:科技出版社,1997.613-615.
  • 6Rabb CH,Tang G,Chin LS,et al.A statistical analysis of factors related to symptomatic cerebral vasospasm.Acta Neurochir(Wien),1994,127:27-31.
  • 7Haley EC,Kassell NF,Torner JC.The international cooperative study on the timing of aneurysm surgery:the North American experience.Stroke,1992,23:205-214.
  • 8Bailes JE,Spetzler RF,Hadley MN,et al.Management morbidity and mortality of poor-grade aneurysm patients.J Neurosurg,1990,72:559-566.
  • 9Adams WM.Time of flight 3D magnetic resonance angiography in the follow-up of coileel cerebral aneurysms.Intervent Neuroradiol,1999,5:127-137.
  • 10Fridriksson S,Saveland H,Jakobsson KE,et al.Intraoperative complications in aneurysm surgery:a prospective national study.Neurosurgery,2002,96:515 -522.

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