颅内前交通动脉瘤开颅夹闭与介入栓塞治疗的比较及文献回顾—单中心166例病例回顾性分析研究

发布时间：2018-04-11 06:54

本文选题：前交通动脉瘤 + 开颅夹闭　；参考：《浙江大学》2014年博士论文

【摘要】：前交通动脉瘤是比较常见的一类颅内动脉瘤,目前临床上对其的治疗方式主要包括开颅动脉瘤切除术和介入动脉瘤栓塞术。然而,由于前交通动脉瘤患者病情复杂,影响临床预后的因素众多,目前国内国外对其的临床治疗方式的选择及预后的判断并无统一意见。客观地讲,不论是开颅动脉瘤切除术还是介入动脉瘤栓塞术,其在前交通动脉瘤的处理方面各有利弊,且与临床中心医生的经验密切相关。因此,本研究就浙医二院神经外科这一临床中心自2012年8月至2013年8月收治的166名前交通动(?)瘤患者行开颅夹闭或介入栓塞治疗情况做一单中心、回顾性分析研究。重点探讨前交通动脉瘤围手术期各种与手术选择及临床预后密切相关的因素对临床决策方面的影响,并对所有患者进行了8-19个月不等的病情随访。经统计分析,本研究认为,本临床中心在处理前交通动脉瘤方面,应首选介入栓塞治疗(尤其对于合并有高血压的患者),对于经评估不适合介入栓塞的患者,行开颅夹闭术应多关注梗死灶形成这一并发症的发生情况,同时对于那些入院时即有影响预后的高风险因素(如Hunt-Hess评分及Fisher评分高),应与患者家属充分沟通,不论采取何种手术方式,预后可能均不理想。
[Abstract]:Anterior communicating aneurysm (ACA) is a common type of intracranial aneurysm. At present, the main treatment methods include craniotomy and interventional aneurysm embolization.However, due to the complex condition of patients with anterior communicating aneurysm, there are many factors that affect the clinical prognosis. At present, there is no unified opinion on the choice of clinical treatment and the judgment of prognosis in domestic and foreign countries.Objectively speaking, both craniotomy and interventional embolization of aneurysms have their advantages and disadvantages in the management of anterior communicating aneurysms, and are closely related to the experience of clinical center doctors.Therefore, 166 patients treated in the clinical center of neurosurgery in the second Hospital of Zhejiang Medical College from August 2012 to August 2013 were studied in this study.The patients underwent craniotomy or interventional embolization for a single-center retrospective study.The influence of various factors closely related to the choice of operation and clinical prognosis in the perioperative period of anterior communicating artery aneurysm on clinical decision-making was discussed and all patients were followed up for 8 to 19 months.According to the statistical analysis, the clinical center should first choose interventional embolization in the treatment of anterior communicating aneurysms (especially for patients with hypertension, for patients who are not evaluated as suitable for interventional embolization).The occurrence of the complication of infarct formation should be paid more attention to during the operation of craniotomy and the high risk factors (such as high Hunt-Hess score and high Fisher score) affecting the prognosis should be fully communicated with the family members of the patients at the same time.The prognosis may not be satisfactory regardless of the operative method.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R739.41

【共引文献】