三维CTA评价显微手术治疗脑动脉瘤破裂出血的临床效果及复发预测

Clinical effect and recurrence prediction with Three dimensional CTA for Microsurgery in cerebral aneurysm Rupture and hemorrhage

摘要:

目的 评价三维CTA（3D-CTA）成像在显微手术治疗脑动脉瘤破裂出血以及预测动脉瘤复发中的应用价值。方法 回顾性总结2016年06月至2017年06月入我院经诊断为脑动脉瘤破裂出血患者共140例，均采用显微手术夹闭瘤颈法治疗，其中60例（观察组）术前和术后1个月采用3D-CTA成像，另80例（对照组）采用DSA成像；比较两组术前诊断动脉瘤位置、形态、长度、瘤颈宽度、瘤体颈比（AR）、入射夹角、高度/载瘤动脉直径（SR）、瘤体钙化及血栓，指导手术成功率和并发症发生率；术后瘤颈夹闭完全率、新发动脉瘤、载瘤动脉狭窄或阻塞、瘤夹滑脱移位、线束硬化伪影和血管对比度值；随访6.0个月，比较动脉瘤复发率。结果 两组术前诊断动脉瘤位置、形态、长度、瘤颈宽度、AR、入射夹角、SR、瘤体钙化及血栓的比较，差异均无统计学意义（P>0.05）。两组指导手术成功率比较无差异，但观察组并发症发生率低于对照组，差异有统计学意义（P<0.05）。两组诊断瘤颈夹闭完全率、载瘤动脉狭窄或阻塞率比较无差异（P>0.05），观察组诊断新发动脉瘤和瘤夹滑脱移位率高于对照组，线束硬化伪影和血管对比度值高于对照组，差异有统计学意义（P<0.05）。两组诊断动脉瘤复发率无差异（P>0.05）。结论 3D-CTA成像在显微手术治疗脑动脉瘤破裂出血的术前、术后以及预测复发中均有较好的应用价值，研究结果还需要进一步验证。

Abstract:

Objective to study values of three dimensional CTA(3D-CTA) for clinical effect evaluation and recurrence prediction in cerebral aneurysm rupture and hemorrhage underwent microsurgery. Methods A total of 140 consecutives as cerebral aneurysm rupture and hemorrhage from June 2016 to June 2017 were enrolled for the retrospective study and received microsurgery clipping neck method,60 cases of which in observation group adopted 3D-CTA before and after operation one month,and other 80 patients in control group got DSA;then to compare differences of aneurysm location,shape,length,width, aspect ratio(AR),incident angle,aneurysm-to-vessel size ratio(SR),calcification and thrombus before operation;guided surgery success rate and complications incidence, total clipping rate of aneurysm neck, new aneurysm, stenosis or obstruction of parent arteries,clips slipping,values of beam hardening artifact and vascular contrast after operation,recurrence rate after six months follow-up. Results The aneurysm location, shape, length,width, AR,incident angle, SR, calcification and thrombus before operation in the two groups were no statistical differences(P>0.05). The surgery success rate in the two groups was no differences(P>0.05),while complications incidence in observation group was significantly lower than control group(P<0.05).The total clipping rate and stenosis or obstruction rate of parent arteries in the two groups was no differences(P>0.05), but new aneurysm and clips slipping rate in observation group was significantly more,values of beam hardening artifact and vascular contrast higher,too(P<0.05).The recurrence rate in the two groups was no differences(P>0.05). Conclusions It is important value of 3D-CTA before and after operation for cerebral aneurysm rupture and hemorrhage underwent microsurgery,and recurrence prediction.