未破裂窄颈小动脉瘤早期行介入栓塞治疗的疗效分析

发布时间：2018-08-20 14:52

【摘要】：目的:分析未破裂的窄颈小动脉瘤早期行介入栓塞治疗的治疗效果,为早期临床治疗未破裂小动瘤提供参考方法:回顾性分析了我院神经外一科2014年1月-2017年1月间73例颅内未破裂小动脉瘤病患病历资料,根据脑血管造影(DSA)检查测得未破裂的颅内动脉瘤直径的大小、动脉瘤颈长、动脉瘤体长,并依此选取小动脉瘤(直径0.5cm)中的窄颈动脉瘤(颈体比≤1/2)并分为介入治疗组和保守观察组。介入治疗组患者于全麻下行介入栓塞治疗,术后均予以脱水降颅压、预防脑血管痉挛、调节电解质平衡等对症治疗。依据动脉瘤完全栓塞的程度分为完全栓塞(100%)、次全栓塞(90%~99%)和失败栓塞(90%)三个等级以便后期随诊观察中参考对比。参考患者的神经功能及康复情况依据GOS预后评分(格拉斯哥预后评分)进行评分,死亡为1分,植物生存为2分,重度残疾为3分,良好为4分以上。两组患者采用电话及门诊随访的方式间隔6个月进行后续跟踪随访,随访率100%。统计并发症发生率,汇总相关数据,采取SPSS 17.0软件进行统计分析,计数资料以比例和百分数(%)表示,组间比较采用?2比较;计量资料以均数±标准差(?s)表示,组间比较采用t检验,检验水准为0.05,P0.05表示有差异,有统计学意义。结果:(1)介入治疗组24例中22例患者(92%)达到完全栓塞,2例患者(8%)达到次级栓塞,但术后随访中未见栓塞的动脉瘤复发变大,变化率为0%。保守观察组中的49例患者中在随访观察过程中有2例患者行影像学检查发现动脉瘤变大,变化率为4%,但差别无统计学意义(P0.05);(2)介入栓塞组中的24例患者中2例患者术后复查CT出现高信号,提示脑出血,经在院对症予以治疗后术后30天GOS预后评分均达4分以上;保守观察组中的49例患者在随诊观察过程中中8例患者动脉瘤破裂致蛛网膜下腔出血行入院治疗,其中的2例患者虽经入院治疗但因病情较重致死亡。统计学计算P0.05,差异有统计学意见;(3)在统计动脉瘤变化情况时,保守观察组中动脉瘤破裂的患者未计算在内,综合两表对比情况,介入治疗组的8%要明显低于保守观察组的20%。结论:通过比较介入治疗和保守观察未破裂的小动脉瘤的治疗效果分析,对于未破裂的小动脉瘤,早期行介入栓塞治疗后能一定程度上降低动脉瘤破裂风险,降低了患者因动脉瘤破裂后出血而导致严重的伤残、甚至死亡的风险;另外未破裂的小动脉瘤患者早期行介入栓塞治疗后在后期的随诊观察过程中可看出术后动脉瘤复发变大情况要明显低于保守观察组中的患者,因而也相应降低了动脉瘤在随诊观察过程中因动脉瘤变化增高的动脉瘤破裂风险率。随着神经影像学的高速发展,越来越多的未破裂小动脉瘤得以被明确诊断,而且生物学、新兴材料学的发展为小动脉的治疗提供了条件,支架辅助、球囊辅助及血流导向装置等新治疗手术大大降低了手术风险及并发症概率,使得更多的患者得以受益。
[Abstract]:Objective: To analyze the therapeutic effect of early interventional embolization for small unruptured aneurysms of narrow neck, and to provide reference for early clinical treatment of small unruptured aneurysms. Narrow carotid aneurysms (neck-to-body ratio < 1/2) of small aneurysms (diameter 0.5 cm) were selected and divided into intervention group and conservative observation group. Patients in intervention group were treated with interventional embolization under general anesthesia, and dehydration was performed after operation to reduce intracranial pressure and prevent cerebrovascular diseases. Symptomatic treatments such as spasm, electrolyte balance adjustment, etc. were classified as complete embolization (100%), subtotal embolization (90%-99%) and failed embolization (90%) according to the degree of complete embolization for later follow-up observation. The neurological function and rehabilitation of the patients were evaluated according to GOS prognostic score (Glasgow prognostic score). Two groups of patients were followed up by telephone and outpatient follow-up for 6 months with a follow-up rate of 100%. The incidence of complications was statistically analyzed, and relevant data were collected. SPSS 17.0 software was used for statistical analysis. The data were counted in proportion and percentage (%) table. Results: (1) In the interventional treatment group, 22 patients (92%) achieved complete embolism, 2 patients (8%) achieved secondary embolism, but no embolism was found in the follow-up. The recurrence rate of aneurysms was 0%. In the conservative observation group, 2 of the 49 patients with aneurysms were found to be enlarged by imaging examination, the change rate was 4%, but the difference was not statistically significant (P 0.05); (2) In the interventional embolization group, 2 of the 24 patients had high signal on CT after operation, suggesting cerebral hemorrhage, and were hospitalized. The GOS prognostic score of 49 patients in the conservative observation group was above 4 on the 30th day after treatment; 8 patients with subarachnoid hemorrhage caused by rupture of aneurysm in conservative observation group were admitted to hospital for treatment, 2 of them were admitted to hospital for treatment but died due to serious illness. The difference was statistically significant (P 0.05). (3) In the conservative observation group, 8% of the patients with ruptured aneurysms were significantly lower than 20% of the conservative observation group when the changes of aneurysms were counted. Conclusion: By comparing the effects of interventional therapy and conservative observation on the treatment of unruptured small aneurysms, the unruptured small aneurysms were analyzed. Early interventional embolization can reduce the risk of rupture of aneurysm to a certain extent, and reduce the risk of serious disability or even death due to bleeding after rupture of aneurysm. With the rapid development of neuroimaging, more and more unruptured small aneurysms have been clearly diagnosed, and biology, emerging materials science has developed into Stent-assisted, balloon-assisted, and blood-flow-guided procedures greatly reduce the risk and probability of complications and benefit more patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

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