显微手术夹闭与血管内介入栓塞治疗颅内破裂动脉瘤的疗效分析

目的 对手术夹闭和血管内介入治疗颅内破裂动脉瘤的疗效作初步分析.方法 对2008年1月-2009年12月在重庆医科大学附一院神经外科治疗的破裂动脉瘤患者进行随访,获得随访信息的病例共109例,病人术前状态采用Hunt-Hess分级评分,其中采用显微神经外科开颅手术79例,Ⅰ-Ⅱ级69例(87.3％),Ⅲ-Ⅴ级10例(12.7％),血管内介入治疗30例,Ⅰ-Ⅱ级26例(86.7％),Ⅲ-Ⅴ级4例(13.3％).出院时手术夹闭组Hunt-Hess分级Ⅰ-Ⅱ级69例全部预后良好,Ⅲ-Ⅴ级10例,6例预后良好,4例预后不良(1例死亡),平均住院恢复时间(22.7±3.2)天；介入栓塞组Hunt-Hess分级Ⅰ-Ⅱ级26例全部预后良好,Ⅲ-Ⅴ级4例,2例预后良好,2例预后不良(1例死亡),平均住院恢复时间(13.4±3.4)天.随访时间3个月～2年.结果 手术夹闭组预后良好76例(96.2％),不良3例(3.8％),其中死亡2例(2.5％),瘫痪1例(1.3％)；介入栓塞组预后良好28例(93 3％),不良2例(6.7％),其中死亡1例(3.4％),瘫痪1例(3.4％).影像学上,手术夹闭组79例随访63例(79.7％),其中稳定59例(93.7％)；介入栓塞组30例病例随访21例(70％),其中稳定19例(90.5％).差异无统计学意义(P=0.625).结论 本研究手术夹闭和介入栓塞两种治疗方法间近期临床效果及随访结果统计学均无显著差异.手术治疗组的完全夹闭率较介入栓塞组的完全栓塞率高,而介入栓塞组平均住院恢复时间明显低于手术夹闭组.

Outcomes of surgical versus endovascular treatment for ruptured cerebral aneurysms

Objective To compare the effecacy of microsurgical clipping versus endovascular coiling in patients with aneurysmal subarachnoid hemorrhage in the first affiliated hospital of Chongqing medical university.Methods To follow-up the patients with subarachnoid hemorrhage(SAH) caused by ruptured intracranial aneurysm in our department from January 2008 to December 2009,109 cases were achieved information.79 cases(69(87.3%)with Hunt-HessⅠ-Ⅱ,10(12.7%) with Hunt-Hess Ⅲ-Ⅴ)were assigned to clip,30 cases(26(86.7%)with Hunt-HessⅠ-Ⅱ,4(13.3%)with Hunt-Hess Ⅲ-Ⅴ)were assigned to coil.when the discharge,in the surgical group,the number with good outcome was 69(69 with Hunt-HessⅠ-Ⅱ),6(10 with Hunt-Hess Ⅲ-Ⅴ),1 case died,the average hospital stay was(22.7±3.2) days.In the endovascular treatment group,the number with good outcome was 26(26 with Hunt-HessⅠ-Ⅱ),2(4 with Hunt-Hess Ⅲ-Ⅴ),1 case died,the average hospital stay was(13.4±3.4)days.Results After 3 months to 2 years’ follow-up,in the surgical group,76 cases(96.2%)with good outcome,3 cases(3.8%)with bad outcome,2 cases(2.5%)died,1 case(3.4%)paralyzed.In the endovascular treatment group,28 cases(93.3%) with good outcome,2 cases(6.7%)with bad outcome,1 case(3.4%)died,1 case(3.4%)paralyzed.Imaging information,63 cases(79.7%)of 79 cases were achieved follow-up in the surgical groups,59 cases(93.7%) were complete occlusion.21 cases(70%) of 30 cases were achieved follow-up in the endovascular treatment group,19 cases(90.5%) were complete occlusion.It did not differ significantly.(P=0.625)Conclusions The short-term clinical results and the outcome of follow-up between the surgical and endovascular treatment groups,do not differ significantly.The complete clipping rate in the surgical group is higher than that the in the endovascular treatment group.The average hospital stay in the endovascular treatment group is shorter than that in the surgical group.