对比一期与分期治疗颅内多发动脉瘤预后并分析动脉瘤破裂原因

Comparative prognosis and analysis of rupture factors in single-stage and multi-stage treatments of multiple intracranial aneurysms

摘要:

目的 探讨一期治疗全部动脉瘤与仅治疗责任动脉瘤的安全性和二期治疗动脉瘤破裂的危险因素。方法 纳入214例颅内多发动脉破裂的瘤患者，一期治疗全部动脉瘤48例，一期仅治疗责任动脉瘤166例，二期治疗36例。临床预后通过改良Rankin量表（MRS）进行评估。结果 一期手术与动脉瘤破裂密切相关的因素为动脉瘤形态、瘤颈大小和纵横比值。对于非责任动脉瘤破裂率而言，仅治疗责任动脉瘤组高于一期治疗全部动脉瘤组（P=0.037）。回归分析提示纵横比值增加与动脉瘤破裂密切相关（P=0.022）。结论 一期手术中全部治疗动脉瘤与仅治疗责任动脉瘤最终的预后无差异，但一期未处理的非责任动脉瘤破裂率较高，非责任动脉瘤破裂风险与其高度与瘤颈比值增加密切相关，且两次手术间隔长短无正相关。

Abstract:

Objective To investigate the safety of one-stage treatment of all aneurysms and only responsible aneurysms and the risk factors for aneurysm rupture in two-stage treatment.Methods A total of 214 patients with multiple intracranial artery rupture were involved， including 48 cases of one-stage treatment of all aneurysms， 166 cases of one-stage treatment of only responsible aneurysms， and 36 cases of two-stage treatment. Clinical outcomes were assessed by the modified Rankin Scale.Results The factors closely associated with aneurysm rupture in one-stage surgery were shape， aneurysmal neck diameter， and aspect ratio. The rupture rate of non-responsible aneurysms was significantly higher in the group with treatment of only responsible aneurysms than in the group with one-stage treatment of all aneurysms （P=0.037）. Multivariate logistic regression analysis suggested that increased aspect ratio was closely associated with aneurysm rupture （P=0.022）.Conclusions There is no difference in the final prognosis between one-stage treatment of all aneurysms and only responsible aneurysms， but the non-responsible aneurysms untreated in the one-stage surgery has a high rupture rate， the risk of non-responsible aneurysm rupture is closely related to the increased aneurysmal height/neck width ratio， and there is no positive correlation with the interval between two surgeries.