50例颅内动脉瘤的临床治疗分析

目的探讨显微外科、介入手术治疗和非手术治疗对颅内动脉瘤的治疗效果。方法总结回顾性分析2001年9月─2008年12月我院收治50例颅内动脉瘤行显微手术（26例）、经血管内介入手术（8例）和非手术治疗（16例）的临床资料。采用电话或信件随访方式来评价患者的预后,随访30例（其余失访）,其中手术病例22例、非手术治疗8例,随访时间6个月至8年。结果全组有3例发生手术前住院死亡。全组手术34例,无手术后长期昏迷和死亡病例,出现并发症20.6%（7/34）;其中,显微手术并发症发生率为23.1%（6/26）,介入手术并发症发生率为12.5%（1/8）。出院时格拉斯哥预后评分（Glasgow outcomscales,GOS）分级,1级3例,2级0例,3级1例,4级6例,5级40例。在随访的30例中,手术组死亡2例,非手术治疗组死亡2例。结论显微外科和介入手术治疗能够显著降低颅内动脉瘤的致死、致残率,是治疗颅内动脉瘤的有效方法,而对颅内动脉瘤采用非手术治疗风险巨大。

Clinical analysis of microsurgical treatment and endovascular treatment for intracranial aneurysm

Objective To investigate the safety and efficacy of the microscopic surgical treatment,endovascular treatment and non-surgical treatment for the intracranial aneurysm.Methods Retrospective analysis of 50 cases of intracranial aneurysms treated by microsurgery（n=26）,endovascular interventional treatment（n=8） and non-surgical treatment（n=16） during Sept.2001-Dec.2008 and follow-up by the methods of telephone or mail to eva-luate patients＇ prognosis.30 cases were followed up（the rest was lost）,in which 22 cases treated by surgical treatment,8 cases of untreated patients were followed up from 6 months to 8 years.Results The hospital mortality occurred in 3 patients.In 34 patients treated by microsurgery and endovascular treatment,there is no long-term coma and post-operative deaths,and the complication rate was 20.6%（7/34）.Microsurgery complication rate was 23.1%（6/26）,interventional endovascular treatment of the complication rate was 12.5%（1/8）.Discharge Glasgow outcom scale（GOS） scores were one grade in 3 cases,2 grade 0 case,3 grade 1 case,4 grade 6 cases and 5 grade 40 cases.30 cases were followed up,2 patients died in surgery group,2 patients died in non-surgical group.Conclusion Microsurgery and interventional treatment can significantly reduce death rate and disability rate of intracranial aneurysms.Surgical treatment of intracranial aneurysms is an effective way,while non-surgical treatment of intracranial aneurysms has a great risk.