颅内动脉瘤血管内治疗中动脉瘤破裂出血的处理

目的探讨血管内治疗颅内动脉瘤术中动脉瘤破裂出血的处理方法和不同结局。方法回顾性分析2007年6月—2011年6月血管内治疗的颅内动脉瘤患者877例,742例接受单纯弹簧圈填塞治疗,135例接受支架辅助弹簧圈填塞治疗。术中动脉瘤破裂出血共23例。术中动脉瘤破裂出血后,继续快速填塞弹簧圈,然后分别采用单纯药物治疗、腰大池引流、开颅血肿清除术等处理方法。出院后半年进行临床随访。结果单纯弹簧圈填塞治疗的术中动脉瘤破裂出血率为1.9%(14/742),支架辅助填塞治疗的术中动脉瘤破裂出血率为6.7%(9/135),差异有统计学意义(χ2=10.218,P=0.001)。23例术中破裂的患者中,10例接受开颅血肿清除,5例存活,5例死亡;7例接受腰大池引流,5例存活,2例死亡;6例接受单纯药物治疗,全部存活。术后半年共随访13例,改良Rankin量表(mRS)评分0分4例,1分2例,2分2例,3分4例,4分1例。结论单纯弹簧圈填塞治疗的术中动脉瘤破裂出血率低于支架辅助弹簧圈栓塞,接受开颅血肿清除术治疗的患者,因病情重预后较差。

Management of aneurysm rupture during endovascular treatment of intracranial aneurysms

Objective To investigate the management methods and the different outcomes of the aneurysm rupture during endovascular treatment of intracranial aneurysms.Methods A total of 877 patients with intracranial aneurysm were treated with endovascular method from June 2007 to June 2011 were analyzed retrospectively,742 patients underwent coil packing therapy alone and 135 underwent stent-assisted coil embolization.A total of 23 patients had intraoperative aneurysm rupture.Quick packing were performed after aneurysm rupture.Then they were treated with simple drug therapy,lumbar cistern drainage or hematoma evacuation,respectively.Clinical follow-up study was conducted at six months after discharge.Results The intraoperative bleeding rate of the simple coil packing was 1.9%（14/742）,and it was lower than that of the stent-assisted embolization（6.7%,9/135）.The difference was statistically significant（χ2=10.218,P=0.01）.Of the 23 patients with intraoperative aneurysm rupture,10 underwent hematoma evacuation,5 survived and 5 died;7 received lumbar cistern drainage,5 survived and 2 died;6 received simple drug treatment and all survived.A total of 13 patients were followed up at six months after procedure.The modified Rankin Scale（mRS） scores were 0 in 4 cases,1 in 2 cases,2 in 2 cases,3 in 4 cases,and 4 in 1 case.Conclusion The mortality was high in the intraoperative bleeding during endovascular treatment of intracranial aneurysms.The prognosis of patients underwent hematoma evacuation was poor.