开颅夹闭术和血管内介入术治疗前循环动脉瘤的对比研究

Comparative study of neurosurgical clipping and endovascular embolization for cerebral anterior circulation aneurysms

摘要:

目的 比较开颅夹闭术和血管内介入术两种方法治疗前循环动脉瘤的疗效。方法 回顾性研究湘潭市中心医院2007年1月至2011年6月按照个体化治疗原则开颅夹闭术治疗的45例和血管内介入术治疗的36例前循环动脉瘤患者的临床资料，对两组患者主要并发症、术后死亡率、恢复优良率、复发率和平均住院时间进行比较，并进行统计学分析，P＜0.05有统计学意义。结果 开颅组术后动脉瘤复发率低于介入组，分别为2.2%和19.4%，开颅组和介入组平均住院天数为16±0.9天及11±0.8天，差异有统计学意义（P<0.05），两组患者术中动脉瘤破裂出血、术后脑血管痉挛、脑积水等并发症的发生率分别为8.9%和8.3%、31.1%和36.1%、2.2%和5.6%，死亡率分别为2.2%和2.8%，恢复优良率分别为82.2%和83.3%，两者比较无统计学差异（P>0.05）。结论 开颅夹闭术和血管内介入术治疗前循环动脉瘤疗效无明显优劣之分，可按照个体化治疗原则，选择其中一种方法进行治疗。

Abstract:

Objective To compare the curative effect between neurosurgical clipping and endovascular coiling in treating patients with anterior circulation aneurysm.Methods A retrospective analysis of 81 anterior circulation aneurysm cases between January 2007 and June 2011 was made. Forty-five cases were performed neurosurgical clipping and the other thirty-six cases received endovascular embolization in xiangtan city central hospital according to the strategy of individualized therapy. Main complications rate(incuding rupture、cerebral vascular spasm and hydrocephalus)、mortality、the good prognosis rate、recurrence rate and hospital stay time between two surgical treatment group were compared by statistical analysis.Results The recurrence rate in neurosurgical clipping and endovascular embolization group was 2.2% and 19.4% respectively, the average median length of hospital stay was 16±0.9 days and 11±0.8 days.The difference between the two groups was of statistical importance. The aneurysm rupture rate、cerebral vascular spasm occurrence、hydrocephalus rate in neurosurgical clipping and endovascular embolization group was 8.9% and 8.3%、31.1% and 36.1%、2.2% and 5.6% respectively.The mortality was 2.2% and 2.8%; the good prognosis rate was 82.2% and 83.3%.There was no significant difference between two groups.Conclusions The curative effect is not of significant difference between neurosurgical clipping and endovascular embolization in treating patients with anterior circulation aneurysm.Surgical treatment strategy should be individually independent.