外科手术夹闭与血管内介入治疗颅内动脉瘤破裂的疗效

目的探讨外科手术夹闭与血管内介入治疗颅内动脉瘤破裂的临床效果。方法回顾性分析218例（248个动脉瘤）颅内破裂动脉瘤患者的临床资料，以颅内动脉瘤患者年龄、入院时Hunt—Hess分级、CTFisher分级、动脉瘤大小以及治疗时间窗为标准分类，比较外科手术夹闭组与血管内介入治疗组颅内动脉瘤患者术后6个月的改良Rankin评分（mRS）。结果处于同-Hunt—Hess分级的颅内破裂动脉瘤患者两种治疗方法的疗效差异无统计学意义（P〉0．05），但Hunt—Hess分级为Ⅰ、Ⅱ级较Ⅲ、Ⅳ、V级患者效果好。CTFisher分级为1、2、4级的颅内动脉瘤患者中，对处于同一分级的患者，两种治疗方法疗效差异无统计学意义（P〉0．05），CTFisher分级为3级的患者血管内介入治疗效果优于外科手术夹闭。处于相同直径大小、相同年龄段的颅内动脉瘤患者应用两种方法治疗后，疗效差异无统计学意义（P〉0．05）。早期治疗时，血管内介入治疗优于外科手术夹闭，中、晚期时两种方法疗效差异无统计学意义（P〉0．05）。外科手术夹闭组中，早期手术夹闭效果优于中、晚期，中期与晚期手术夹闭的效果无差异；血管内介入治疗组早、中、晚期的效果差异无统计学意义（P〉0．05）。结论外科手术夹闭与血管内介入治疗均适合颅内动脉瘤的治疗。处于CTFisher分级为3级、治疗时间窗为早期的颅内动脉瘤，血管内介入治疗优于外科手术夹闭；两种治疗方法长期临床效果差异仍待大宗病例随访和总结。

Effects of surgical clipping and endovascular treatment on ruptured cerebral aneurysms

Objective To compare the clinical effects of neurosurgical clipping and endovascular coiling on ruptured intracranial aneurysm, and investigate the best therapeutic method of these two meth-ods in treating ruptured intracranial aneurysms and find out the best therapeutic time. Methods From Jan 2005 to Dec 2012, the clinical data of 218 patients with ruptured intracranial aneurysm were selected and analyzed retrospectively. Patients were classified according to Hunt-Hess and Fisher grade, aneurysm size, patients age, time window of treatment. Modified Rankin Scale （mRS） at 6 months after operation were compared between the two groups. Results There was no significant difference between the two methods for patients of the same Hunt-Hess. But the therapeutic effect of Hunt-Hess Ⅰ - Ⅱ patients was better than that of Hunt-Hess Ⅲ-Ⅴ. There was no significant difference between the two methods for pa-tients of Fisher grade 1, 2, 4, while endovascular treatment was better than surgical clipping for Fisher grade 3. There was no significant difference between the two methods for patients of the same aneurysm size, patients age. Endovascular treatment was better than surgical clipping for patients of early treat-ment, while there was no significant difference between the two methods for patients with moderate and advanced stage. For surgical clipping group, early treatment was better than moderate and advanced stage, while there was no significant difference between moderate and advanced stage. For endovascular treatment group, there was no significant difference among the three stages. Conclusions Surgical clip-ping and endovascular treatment are both suitable for aneurysm treatment. There is no significant differ-ence between the two methods for patients of the same Hunt-Hess, Fisher 1, 2, 4, anatomical size, pa-tients age and in moderate and advanced stage. But endovascular treatment is better than surgical clipping for patients of Fisher 3 and operation in early stage. The long-term effect of surgical clipping and endo-vascular treatment need further investigation.