颅内破裂动脉瘤早期显微手术与血管内栓塞治疗的临床应用

目的 分析颅内破裂动脉瘤早期行显微手术与血管内介入治疗的临床疗效,探讨对不同形式的颅内动脉瘤及不同病情患者的治疗方法.方法 对214例颅内破裂动脉瘤患者早期（起病3d内）采用显微手术或血管内介入治疗,根据患者入院时的Hunt-Hess（HHS）病情分级结合治疗后1个月时患者的格拉斯哥预后评分（GOS）分析其治疗结果,其中显微手术128例（HHS Ⅳ～Ⅴ级占30例）,经血管内栓塞86例（HHS Ⅳ～Ⅴ级占17例）.结果 98例HHS Ⅰ～Ⅲ级显微手术者1个月后GOS评分5分（恢复良好）76例,4分（轻度残疾）13例,3分（严重残疾）6例.2分（植物生存）2例,1分（死亡）1例;69例HHS Ⅰ～Ⅲ级血管内介入治疗者1个月后GOS评分5分54例,4分9例,3分4例,2分1例,1分1例,两组HHS Ⅰ～Ⅲ级患者治疗效果的差异无统计学意义（P〉0.05）.30例HHS Ⅳ～Ⅴ级显微手术者1个月后GOS评分5分8例,4分6例,3分8例,2分4例,1分4例;17例HHS Ⅳ～Ⅴ级血管内栓塞治疗者1个月后GOS评分5分2例,4分2例,3分2例,2分4例,1分7例,两组HHS Ⅳ～Ⅴ级患者治疗效果的差异有统计学意义（P〈0.01）.结论 HHS Ⅰ～Ⅲ级动脉瘤患者显微手术与血管内介入治疗疗效无明显差异,而Ⅳ～Ⅴ级动脉瘤患者倾向于显微手术治疗,部分患者联合应用两种方法效果更好,远期疗效还需要长期随访.

Comparative study on initial microsurgery and endovascular embolization for ruptured intracranial aneurysms

Objective To compare microsurgery and endovascular embolization in treatment of ruptured intracranial aneurysms. Methods Two hundred and fourteen patients with ruptured intracranial aneurysms with 3 days were assigned to microsurgery or endovascular embolization groups. The therapeutic effects were analyzed according to Hunt-Hess standard （HHS） of admit-patients and GOS grade at one month after treatment. Results Ninety eight patients of HHS Ⅰ～Ⅲ received micro- surgery, according to the GOS grade one month after operation, 5 scores （satisfactory recovery） were obtained in 76 patients, 4 scores （mild disability） in 13, 3 scores （severe disability） in 6, 2 scores （vegetative state ） in 2 and 1 score （death） in 1; among 69 patients receiving endovascular embolization, 5 scores were obtained in 54, 4 scores in 9,3 scores in 4,2 scores in 1 and 1 score in 1. Thirty patients of HHSVINV received microsurgery, 5 scores were obtained in 8, 4 scores in 6, 3 scores in 8, 2 scores in 4 and 1 score in 4; among 17 patients of HHSVI~V after endovascular embolization, 5 scores were obtained in 2,4 scores in 2,3 scores in 2,2 scores in 4 and 1 score in 7, There were no statistical differences in therapeutic effects between the two groups of HHS Ⅰ～Ⅲ （P〉 0.05）, but were significant differences between the two groups of HHSVI-V （P〈 0.01）. Conclusions For HHS Ⅰ～Ⅲ patients there is no significant difference between microsurgery and endovascular embolization, while for HHS Ⅳ～Ⅴ-V patients mi- crosurgery may have better results than endovascular embolization in treatment of intracranial ruptured aneurysms.