MDS与GDC囊内栓塞治疗颅内动脉瘤初步比较(附120例125个动脉瘤报告)

目的　比较机械可脱式弹簧圈(mechanicaldetachablespiral,MDS)与电解可脱式弹簧圈(Guglielmidetachablecoil，GDC)囊内栓塞颅内动脉瘤。方法　对比分析1995年3月至1999年7月120例125个动脉瘤中，用MDS栓塞的(64例66个)与用GDC栓塞的(48例51个)病人、动脉瘤、栓塞结果和并发症等情况。结果　MDS和GDC两组病人的性别、年龄、治疗前有否蛛网膜下腔出血、Hunt-Hess氏分级、动脉瘤体长径(8.46±3.42mm与7.38±3.45mm)和颈宽(3.49±1.50mm与3.26±1.52mm)、栓塞所用弹簧圈的平均个数(4.65±3.04与4.24±2.65)和长度(460.2±398.5mm与422.9±387.1mm)、栓塞百分比(95.00%±6.32%与94.19%±7.63%，栓塞≥80%的病例)、以及死亡和永久并发症合计发生率(7.8%与4.2%)等均无显著性统计差异(t或χ2检验，P值均＞0.10)。结论　MDS和GDC都是颅内动脉瘤栓塞治疗的有效材料。MDS价格相对较低，操作需一定的经验和技巧；GDC选择规格多，操作相对简单、安全，适应证更宽。正确选择MDS或GDC(或联合应用)，可安全有效经济地治疗动脉瘤。

Analysis of intracranial aneurysm embolization with MDS and with GDC

Objective　To evaluate the MDS(Mechanical Detachable Spiral)/GDC (Guglielmi Detachable Coil) embolization effects of intracranial saccular aneurysms. Methods　Among 120 cases of intracranial aneurysm (125) during March 1995 to July 1999, 65 cases (66 aneurysms) were embolized with MDS, 48 (51) with GDC and 8 with a combination of MDS and GDC. Clinical material including sex, age, SAH and Hunt & Hess Scale, diameter and neck width of aneurysm, the number and length of coils used per aneurysm, occlusive ratio and complications were compared between MDS and GDC groups. Results　MDS and GDC groups were comparable (P＞0.10) in terms of age, sex, diameter of aneurysm(8.46±3.42mm verse 7.38±3.45mm), neck width (3.49±1.50mm NS 3.26±1.52mm). Among those occluded ≥80%, MDS verse GDC: the average occlusive ratios, 95.00%±6.32∶94.19%±7.63%；permanent complications (including death), 7.8% NS 4.2%；Average coils and length per aneurysm, 4.65±3.04 NS 4.24±2.65 and 460.2±398.5mm NS 422.9±387.1mm. Conclusions　Although no significant differeace was found when compared MDS with GDC, GDC is more preferable regarding its good compliance, alternative types ready for use, tractability, especially for early ruptured and wide-neck aneurysms. Comparably, MDS is not promising as to its difficulty of control, possible propensity of complication, and potentiality of dissolution in spite of its good thrombogenesis and inexpensiveness.