引用本文:钟 书,庞 刚,唐玺和,陈海浚,梁有明,徐柯贝,李希圣,蓝胜勇,叶 劲,唐秀文.破裂性大脑中动脉宽颈动脉瘤支架辅助管栓塞治疗与开颅夹闭术治疗的对比研究[J].中国临床新医学,2019,12(6):600-603.
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破裂性大脑中动脉宽颈动脉瘤支架辅助管栓塞治疗与开颅夹闭术治疗的对比研究
钟 书,庞 刚,唐玺和,陈海浚,梁有明,徐柯贝,李希圣,蓝胜勇,叶 劲,唐秀文
530021 南宁,广西壮族自治区人民医院神经外科
摘要:
[摘要] 目的 探讨开颅夹闭术与血管内介入支架辅助管栓塞治疗大脑中动脉(MCA)宽颈动脉瘤的疗效及安全性。方法 回顾分析2014-01~2018-03 73例自发性蛛网膜下腔出血(SAH)的MCA分叉处宽颈动脉瘤患者的临床资料,以治疗方式的不同分为动脉瘤手术夹闭术组35例和支架辅助血管内介入治疗组38例。分析患者的动脉瘤特征、SAH的Hunt-Hess分级、合并颅内血肿、手术并发症(如术中动脉瘤破裂再出血、术后脑梗死、切口/颅内感染)等资料;评价治疗效果的指标包括动脉瘤闭塞率、术后1个月、6个月的格拉斯哥预后量表(Glasgow Outcome Scale,GOS)评分,应用DSA或CTA检查评估动脉瘤闭塞情况。结果 介入治疗组38例,其中37例成功实施血管内介入治疗术,1例介入治疗失败转开颅夹闭术,术后即刻造影结果显示,动脉瘤致密性栓塞27例,次全栓塞9例,部分栓塞2例。夹闭术组35例,其中34例成功夹闭动脉瘤,1例夹闭失败转介入治疗。两组闭塞率和复发率比较差异无统计学意义(P>0.05)。介入治疗组术后脑梗死、术后感染发生率低于夹闭术组,差异有统计学意义(P<0.05)。两组治疗后1个月、6个月GOS评分比较差异无统计学意义(P>0.05)。结论 血管内介入支架辅助栓塞治疗破裂性MCA宽颈动脉瘤成功率较高,手术并发症发生率较低,是一种安全、有效的颅内动脉瘤治疗术式,但仍需要更大样本研究和长期随访结果进一步验证。
关键词:  大脑中动脉宽颈动脉瘤  开颅显微手术  血管内介入  支架辅助
DOI:10.3969/j.issn.1674-3806.2019.06.05
分类号:R 732.2+1
基金项目:广西科学研究与技术开发计划项目(编号:桂科攻1355005-4-7)
Comparative study of stent-assisted embolization and craniotomy clipping microsurgery on ruptured middle cerebral artery wide-necked aneurysm
ZHONG Shu, PANG Gang, TANG Xi-he, et al.
Department of Neurosurgery, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
Abstract:
[Abstract] Objective To explore the efficacy and safety of craniotomy clipping and endovascular stent assisted embolization in the treatment of middle cerebral artery(MCA) wide-necked aneurysms. Methods The clinical data of 73 patients with spontaneous subarachnoid hemorrhage(SAH) of MCA wide-necked aneurysms treated between January 2014 and March 2018 were retrospectively analyzed, among whom 35 cases were enrolled in the microsurgical clipping group and 38 cases in the stent assisted intravascular interventional therapy group. The characteristics of aneurysms, Hunt-Hess grade of SAH, intracranial hematoma, surgical complications such as intraoperative aneurysm rupture and re-bleeding, postoperative cerebral infarction, incision/intracranial infection and other data were analyzed. The indexes to evaluate the therapeutic effect included aneurysm occlusion rate, Glasgow Outcome Scale(GOS) at 1 month and 6 months after surgery, and digital substraction angiography(DSA) or computed tomography angiography(CTA) examination was used to evaluate the aneurysm occlusion. Results Of the 38 cases of the interventional group, 37 cases were successfully treated with endovascular interventional therapy. Only 1 case in the interventional group was transferred to craniotomy clipping after failure of the interventional therapy. The immediate postoperative angiography results showed that there were 27 cases of aneurysm dense embolization, 9 cases of secondary complete embolization, and 2 cases of partial embolization. Of the 35 cases of the clipping group, 34 cases were successfully clipped, and 1 case was transferred to interventional therapy after clipping failure. There were no significant differences in the occlusion rate and the postoperative recurrence rate between the two groups(P>0.05). The incidence of cerebral infarction and the postoperative infection rate in the interventional group were lower than those in the clipping group, with statistically significant differences(P<0.05). There were no significant difference in the GOS scores between the two groups 1 month and 6 months after treatment(P>0.05). Conclusion Endovascular stent assisted embolization is a safe and effective method for the treatment of intracranial aneurysms with a high success rate and less complications, but it still needs to be further validated by larger sample studies and long-term follow-up results.
Key words:  Middle cerebral artery(MCA) wide-necked aneurysm  Craniotomy microsurgery  Intravascular intervention  Stent assisted