摘要
目的探讨Pipeline血流导向装置(PED)治疗椎-基底动脉未破裂夹层动脉瘤的安全性和有效性,以及影响动脉瘤完全愈合的相关因素。方法选取自2019年3月至2023年3月于北部战区总医院神经外科行PED治疗的31例椎-基底动脉夹层动脉瘤患者为研究对象。采用改良Rankin量表评分评估患者临床预后。术前及术后均通过数字减影血管造影(DSA)影像观察动脉瘤愈合程度,对DSA影像采用O‘Kelly-Marotta分级量表进行评估,并根据动脉瘤是否完全愈合将患者分为完全愈合组与不完全愈合组。收集患者的相关临床资料,并通过单因素分析和多因素Logistic回归分析影像动脉瘤愈合完全的因素。结果所有患者均顺利完成手术,其中,单用PED栓塞17例,PED+弹簧圈栓塞14例。缺血性并发症共发生4例(12.9%),其中,围术期发生缺血性并发症2例(6.5%),均为急性血栓形成,均予以溶栓或取栓处理,术后恢复尚可,术后远期发生缺血并发症2例(6.5%);出血性并发症共发生1例(3.2%),为术中动脉瘤破裂。随访患者中,动脉瘤完全愈合21例设为完全愈合组,不完全愈合10例设为不完全愈合组。单因素分析显示,完全愈合组和不完全愈合组的有无填圈及有无造影剂滞留静脉期患者比例比较,差异均有统计学意义(P<0.05);多因素分析结果显示,填圈和造影剂滞留静脉期均为促使动脉瘤完全愈合的影响因素(P<0.05)。结论对于后循环夹层动脉瘤,PED治疗的动脉瘤闭塞率较高,效果良好,但术后并发症不容忽视,临床应注意防治,结合弹簧圈治疗更有利于动脉瘤的愈合。
Objective To investigate the safety and efficacy of Pipeline blood flow guidance device(PED)in the treatment of unruptured vertebrobasilar dissected aneurysms and the related factors affecting the complete healing of aneurysms.Methods Thirty-one patients with vertebra-basilar artery dissection aneurysm who received PED treatment in the Department of Neurosurgery in General Hospital of Northern Theater Command from March 2019 to March 2023 were selected as the study objects.The clinical prognosis of the patients was evaluated using the modified Rankin scale score.The degree of aneurysm healing was observed by digital subtraction angiography(DSA)images before and after surgery.The DSA images were evaluated by O′Kelly-Marotta rating scale,and the patients were divided into complete union group and incomplete union group according to whether the aneurysm was completely healed.The relevant clinical data of patients were collected,and the factors of complete aneurysm healing were analyzed by univariate analysis and multivariate Logistic regression.Results All patients successfully completed the operation,of which 17 cases were embolized by PED alone,and 14 cases were embolized by PED and spring coil.Ischemic complications occurred in 4 cases(12.9%)of which 2 cases(6.5%)occurred perioperative ischemic complications,all of which were acute thrombosis and were treated with thrombolysis or thrombolysis.Postoperative recovery was satisfactory,and 2 cases(6.5%)occurred long-term ischemic complications after surgery.Hemorrhage complication occurred in 1 case(3.2%),which was rupture of aneurysm during operation.In the follow-up patients,21 cases of complete aneurysm healing were included in the complete union group and 10 cases of incomplete aneurysm healing were included in the incomplete union group.Univariate analysis showed that there were statistically significant differences in the proportion of patients with or without filling circle and with or without contrast agent in venous retention between the complete healing group and the incomplete healing group(P<0.05).The results of multi-factor analysis showed that the filling circle and the venous retention period of contrast agent were the influencing factors for the complete healing of aneurysms(P<0.05).Conclusion For posterior circulation dissection aneurysms,PED treatment has a high rate of aneurysm occlusion and good effect,but postoperative complications should not be ignored,clinical attention should be paid to prevention and treatment,combined with spring coil treatment is more conducive to aneurysm healing.
作者
陈宏祥
杨芳宇
赵玉龙
刘佳明
杜舜尧
唐一淳
范泽政
高旭
CHEN Hong-xiang;YANG Fang-yu;ZHAO Yu-long;LIU Jia-ming;DU Shun-yao;TANG Yi-chun;FAN Ze-zheng;GAO Xu(Department of Neurosurgery,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《临床军医杂志》
CAS
2024年第4期351-355,359,共6页
Clinical Journal of Medical Officers
基金
辽宁省自然科学基金(2021-KF-12-02)。
