介入栓塞与开颅瘤颈夹闭术治疗颅内动脉瘤的术前评估研究

目的评估介入栓塞与开颅瘤颈夹闭术治疗颅内动脉瘤的术前相关危险因素。方法回顾性分析颅内动脉瘤患者120例,根据手术方式分为开颅夹闭组及介入栓塞组各60例;记录术前相关影响因素及术后恢复情况,分析比较性别、年龄、Fisher分级、Hunt-Hess分级、动脉瘤部位、动脉瘤长轴与颈宽比(AR)、高血压及高血糖等术前影响因素对开颅夹闭术和血管内介入栓塞术治疗颅内动脉瘤疗效的影响。结果年龄是手术治疗的影响因素,60岁以上患者预后明显差于60岁以下患者(P0.05);Fisher分级中Ⅰ、Ⅱ级患者的预后明显优于Ⅲ、Ⅳ级患者(P0.05);Hunt-Hess分级越高,预后效果越差,但开颅夹闭术与介入栓塞术2组比较无明显差异(P0.05);动脉瘤的部位对预后有显著影响(P0.05),动脉瘤长颈和瘤颈比值(AR)对介入栓塞术组影响较大(P0.05),随着AR值增大采用介入栓塞术的疗效明显好转(P0.05);高血压及高血糖对介入栓塞术治疗的影响较小(P0.05);不同年龄对临时阻断载瘤动脉时间的耐受能力不同,导致其预后疗效有显著差异(P0.05)。结论年龄、Fisher分级、Hunt-Hess分级及动脉瘤部位是颅内动脉瘤患者开颅夹闭术和血管介入栓塞术术后疗效的共同影响因素。

Study on preoperative evaluation of interventional embolization and neurosurgical clipping in the treatment of in-tracranial aneurysm

Objective To evaluate the preoperative risk factors of interventional embolization and neurosurgical clipping in the treatment of intracranial aneurysm.Methods 120 Patients with intracranial aneurysm from March 2011 to March 2015 in our hospital were retrospectively analyzed,they were divided into group interventional embolization (60 cases)and group of neurosur-gical clipping (60 cases according to surgical methods).Preoperative related factors and postoperative recovery were noted,and the influences of gender,age,Fisher grades,Hunt-Hess classification,aneurysm site,ratio of long axis (AR),hypertension and hyper-glycemia on the clinical effect of interventional embolization and neurosurgical clipping in the treatment of intracranial aneurysm were analyzed.Results Age was a factor of surgical treatment,the prognosis of patients over the age of 60 were significantly worse than patients under 60 years of age (P <0.05).Patients of Fisher grading Ⅰ and Ⅱ showed a better prognosis than that of Fisher grading Ⅲ and Ⅳ (P <0.05);Hunt-Hess grade higher,the prognosis were worse,but there was no significant difference between the surgery of terventional embolization and neurosurgical clipping (P >0.05);the site of aneurysm had significantly in-fluence on prognosis (P <0.05),long-necked aneurysm and the aneurysm neck ratio (AR)had a greater impact on the group of terventional embolization;with the use of AR value increased,the efficacy of interventional embolization were significantly improved (P <0.05 ).Hypertension and hyperglycemia had less influence on interventional embolization (P > 0.05 ).Different ages for temporary occlusion of parent artery time tolerance led to differences in the prognosis (P < 0.05 ).Conclusion Age, Fisher grade,Hunt-Hess grade and aneurysm site were the common factors of interventional embolization and neurosurgical clip-ping in the treatment of intracranial aneurysm.