颅内小动脉瘤（≤4mm）介入栓塞与开颅手术临床疗效对比研究

发布时间：2018-03-01 22:09

  本文关键词： 颅内小动脉瘤(≤4mm) 介入栓塞 开颅夹闭　出处：《延安大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:回顾性分析介入栓塞及开颅手术治疗颅内破裂小动脉瘤(≤4mm)临床预后结果,比较两种治疗方法的疗效,探讨两种治疗方法的优缺点,为临床医学实践操作及科学研究提供相关的理论依据。方法:1.研究对象收集2010年10月至2015年10月期间就诊于广州军区武汉总医院的颅内破裂小动脉瘤(≤4mm)患者共511例,其中介入栓塞组261例,开颅手术治疗组250例。入选标准:(1).经CT或腰椎穿刺证实SAH;(2).双平板DSA机3D旋转血管成像术确诊最大动脉瘤直径≤4mm;(3).多发动脉瘤患者,主要由小动脉瘤导致的蛛网膜下腔出血。所有患者治疗前均经过本院神经外科及介入医师术前讨论,患者本人或家属签署知情同意书。2.主要设备及技术德国西门子公司Artis zee biplane双平板DSA机,System syngo X-WP三维后处理系统,常规DSA图像采集,经颈内动脉、颈外动脉、椎动脉分别给与造影剂,颈内动脉3ml/s,总量18ml,椎动脉2.5ml/s,总量15ml,采用“5sDSA模式”,图像自动传输至三维后处理系统进行测量动脉瘤大小及了解动脉瘤部位。3.统计学方法采用SPSS19.0统计软件,计量资料以均数±标准差(X±S)表示,计数资料以百分比表示。组间比较用T检验、分类资料行卡方检验(或Fisher确切概率分析),多个样本非参数检验秩和检验采用Kruskal-Wallis。检验水准为α=0.05,检验水平为P0.05为有统计学意义。结果:介入栓塞组261例,性别:男105(40.0%)例,女156(60.0%)例,年龄52.65±10.4岁,既往吸烟史40(15.3%)例,高血压史118(45.2%)例,冠心病史9(3.4%)例,糖尿病史16(6.1%)例,术前出现脑积水39(14.9%)例,发病到治疗时间2.69±4.7天,入院时hunt-hess分级1-3级214(82.1%)例,4-5级47(17.9%)例,fisher分级0-2级165(63.2%)例,3-4级96(36.8%)例,动脉瘤位于前循环240(92%)例,后循环21(8%)例,窄颈67(25.7%)例,宽颈194(74.3%)例。开颅夹闭共250例,性别:男96(38.4%),女154(61.6%),年龄52.79±9.6岁,既往吸烟史37(14.8%)例,高血压史101(40.4%)例,冠心病史8(3.2%)例,糖尿病史10(4.0%)例,术前出现脑积水37(14.8%)例,发病到治疗时间2.52±3.6天,入院时hunt-hess分级1-3级192(76.8%)例,4-5级58(23.2%)例,fisher分级0-2级150(60.0%)例,3-4级100(40%)例,动脉瘤位于前循环234(93.6%)例,后循环16(6.4%)例,窄颈88(35.2%)例,宽颈162(64.8%)例。临床结果1年回访介入组良好(mrs0-2分)187例(71.6%)、残疾(mrs3-5分)68例(26.1%,)、死亡(mrs6分)6例(2.3%)。开颅夹闭组1年回访良好(mrs0-2分)171例(68.4%)、残疾(mrs3-5分)74例(29.6%,)、死亡(mrs6分)5例(2.0%)。介入组1年内复发6例(2.3%),夹闭组1年内复发8例(3.1%)。两组治疗预后在统计学上无差异。两组患者住院期间平均花费介入治疗组120527.5±48152.7元,开颅夹闭组121985±55070.4元,两组统计无明显差异,患者住院平均天数介入组16.99±10.8天,开颅夹闭组21.1±11.6天,两组统计分析(p0.05),两组数值在统计学存在明显差异。结论:目前颅内破裂小动脉瘤(≤4mm)的主要治疗方法是开颅夹闭及介入栓塞两种,而且目前多数临床中心主张介入栓塞治疗。我们的研究发现:从短期研究分析,介入栓塞与开颅夹闭对于颅内破裂小动脉瘤的治疗只有在住院时间有差异,其它评估资料中:住院手术花费、术后恢复情况、术中并发症及术后并发症等各项评估指标在两组之间均无统计学差异。对此,我们总结以下几点:1.介入栓塞在颅内小动脉瘤的治疗中,随着介入技术及材料学的发展,手术的安全性较开颅手术无明显差异;2.介入栓塞因其手术创伤小,术后恢复快,将被越来越多的医务人员及患者所接受;3.因其动脉瘤体积小,两种手术治疗费用上无明显差异,这使得在经济上困难的患者可以优先选择介入治疗;4.支架技术的使用在小动脉瘤的治疗中较其它类型动脉瘤多,因其随访时间短,对于其远期影响需要长期观察。总之,介入栓塞手术在未来小动脉瘤的治疗中将占主导地位,在治疗选择中应优先考虑。
[Abstract]:Objective: To retrospectively analyze the interventional embolization and craniotomy for treatment of ruptured intracranial aneurysms (4mm) clinical outcome, the curative effect of two treatment methods, advantages and disadvantages of two kinds of treatment methods, for the clinical practice and scientific research operations provide relevant theoretical basis. Methods: 1. intracranial research object from October 2010 to during October 2015 in Wuhan General Hospita of Guangzhou Military Region from the ruptured aneurysm (4mm) patients in 511 cases, of which 261 cases of interventional embolization group, treatment group 250 cases of craniotomy. Inclusion criteria: (1). After CT or lumbar puncture confirmed SAH; (2). DSA 3D double plate rotation angiography confirmed the largest aneurysm the diameter is less than or equal to 4mm; (3). Multiple aneurysms were mainly caused by aneurysm subarachnoid hemorrhage. All patients were in the hospital department of neurosurgery and interventional physicians after preoperative discussion, the patients themselves or their families Signed informed consent.2. main equipment and technology of Germany's SIEMENS Artis Zee biplane DSA System syngo double plate machine, X-WP 3D postprocessing system, conventional DSA image acquisition, through the internal carotid artery, external carotid artery, vertebral artery and internal carotid artery were given contrast agent, 3ml/s, total 18ML, total 15ml, 2.5ml/s of vertebral artery, the the "5sDSA" model, automatic image postprocessing system for transmission to the 3D measurement of aneurysm and understand the aneurysm site.3. were analyzed using the SPSS19.0 statistical software, measurement data to mean + standard deviation (X + S) said the count data expressed as a percentage. Between the two groups using T test for categorical data card square test (or Fisher exact probability analysis), multiple samples of non parametric test and rank test using the Kruskal-Wallis. test standards for a =0.05, the test level is P0.05 as statistically significant. Results: 261 cases of interventional group, 鎬у埆:鐢，

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