血管内弹簧圈栓塞与显微外科手术夹闭治疗破裂颅内动脉瘤：回顾性病例系列研究

目的：探讨血管内弹簧圈栓塞与显微外科手术夹闭颅内破裂动脉瘤的有效性和安全性。方法回顾性纳入血管内弹簧圈栓塞或显微外科手术夹闭治疗的颅内破裂动脉瘤患者，对接受血管内弹簧圈栓塞与显微外科手术夹闭治疗患者的人口统计学、基线临床资料以及转归和并发症进行比较。结果共纳入85例颅内破裂动脉瘤患者，其中40例采用显微外科手术夹闭治疗（手术夹闭组），45例采用血管内弹簧圈栓塞治疗（血管内栓塞组）。手术夹闭组和血管内栓塞组男性（37.5％对40.0％；χ2＝0.056， P＝0.813）、高血压（30.0％对33.3％；χ2＝0.109， P＝0.742）、吸烟（50.0％对48.9％；χ2＝0.010，P＝0.918）、饮酒（45.0％对46.7％；χ2＝0.024，P＝0.878）、动脉瘤部位（前交通动脉：50.0％对48.9％；后交通动脉：35.0％对33.3％；大脑中动脉：10.0％对11.1％；椎动脉：5.0％对6.7％；P均>0.05）、动脉瘤最大直径<10 mm（80.0％对77.8％；χ2＝0.063，P＝0.802）、Hunt-Hess分级1~2级（55.0％对57.8％；χ2＝0.066，P＝0.797）、Fisher分级1~2级（60.0％对57.8％；χ2＝0.043， P＝0.835）和发病至治疗时间<72 h（62.5％对64.4％；χ2＝0.035，P＝0.853）患者的构成比均无显著差异。手术夹闭组和血管内栓塞组动脉瘤完全闭塞率（97.5％对91.1％；P＝0.364）和转归良好率（65.0％对68.9％；χ2＝0.145， P＝0.703）均无显著差异；手术夹闭组无死亡病例，血管内栓塞组死亡1例（2.2％），但无显著性差异（P＝1.000）；手术夹闭组有1例（2.5％）发生脑梗死，血管内栓塞组未发生脑梗死，亦无显著差异（ P＝0.471）。结论显微外科手术夹闭在治疗破裂颅内动脉瘤的疗效和安全性与血管内弹簧圈栓塞相当。

Endovascular coiling and microsurgical clipping for the treatment of ruptured intracranial aneurysms:a retrospective case series study

Objective To investigate the effectiveness and safety of endovascular coiling and microsurgical clipping for ruptured intracranial aneurysms. Methods Patients w ith ruptured intracranial aneurysm treated w ith endovascular coiling or microsurgical clipping w ere enrol ed retrospectively. The demography, baseline clinical data, outcome, and complications in patients received endovascular coiling and microsurgical clipping w ere compared. Results A total of 85 patients w ith ruptured intracranial aneurysm were enroled, including 40 were treated with microsurgical clipping (surgical clipping group) and 45 were treated w ith endovascular coiling (endovascular coiling group). There w ere no significant differences in the proportions of the patients in male (37.5%vs.40.0%; χ2 =0.056, P=0.813), hypertension (30.0%vs. 33.3%; χ2 =0.109, P=0.742 ), smoking ( 50.0%vs.48.9%; χ2 =0.010, P=0.918 ), drinking (45.0%vs.46.7%; χ2 =0.024, P=0.878), aneurysm site (anterior communicating artery: 50.0%vs. 48.9%;posterior communicating artery:35.0%vs.33.3%; middle cerebral artery:10.0 %vs.11.1%;vertebral artery: 5.0%vs.6.7%; al P>0.05), aneurysm maximum diameter < 10 mm (80.0%vs. 77.8%;χ2 =0.063, P=0.802), Hunt-Hess grade 1-2 (55.0%vs.57.8%; χ2 =0.066, P=0.797), Fisher grade 1-2 ( 60.0%vs.57.8%; χ2 =0.043, P=0.835 ), and time from onset to treatment < 72 h (62.5%vs.64.4%; χ2 =0.035, P=0.853) in the surgical clipping group and endovascular coiling group. There w ere no significant differences in the complete occlusion rate of aneurysms ( 97.5%vs.91.1%;P=0.364) and the good outcome rate (65.0%vs.68.9%; χ2 =0.145, P=0.703) betw een the surgical clipping group and the endovascular coiling group. No patients died in the surgical clipping group and 1 patient died in the endovascular coiling group, and there w as no significant difference ( P=1.000). One patient (2.5%) had cerebral infarction in the surgical clipping group and no patients had cerebral infarction in the endovascular coiling group, and there w as no significant difference ( P=0.471). Conclusions The efficacy and safety of microsurgical clipping are the same as those of endovascular coiling for ruptured intracranial aneurysms.