血管内支架辅助电解铂金弹簧圈治疗颅内宽颈动脉瘤的疗效分析

发布时间：2018-06-27 23:51

本文选题：宽颈动脉瘤 + 支架　；参考：《延安大学》2015年硕士论文

【摘要】：【目的】:探讨支架辅助弹簧圈栓塞治疗颅内宽颈动脉瘤的技术特点,并评价其临床疗效的安全性、可行性及长期稳定性。【方法】:对我院自2012年4月到2015年1月期间接受支架辅助弹簧圈栓塞治疗的40例颅内宽颈动脉瘤患者作为研究对象,共43枚动脉瘤,均为破裂动脉瘤。40例患者术前均全麻下行脑血管造影,主要目的是对动脉瘤的瘤颈及瘤体与瘤颈的比值进行测量,对动脉瘤的形态以及其在颅内的毗邻关系进行确切的定位,以便后续制定手术方案。手术结束后常规造影并依据Raymond分级量表判定后详细记录结果,以便于和造影随访结果进行分析讨论。本组病例采用两种术后随访手段:影像学随访:我们对随访患者分别在术后6个月、12个月行造影检查,将最近一次造影随访结果用Raymond分级量表详细记录,然后对随访造影结果与初次造影结果进行统计分析,比较两次造影结果有何变化并判断栓塞效果是否稳定。临床随访:术后通过门诊和电话等方式,进行临床随访,结果使用改良Rankin量表(Modified Rankin scale,MRS)记录。【结果】:支架辅助弹簧圈栓塞的43枚宽颈动脉瘤中,支架释放位置均满意。43枚动脉瘤中42枚进行了不同程度的填塞,其中1例行支架置入后再行弹簧圈填塞时发现弹簧圈无法进入动脉瘤内,仅予支架置入。即可造影显示动脉瘤不显影,提示封堵满意,未使用弹簧圈。42枚不同程度填塞动脉瘤的初次造影结果:83.3%(35/42枚)完全栓塞,11.9%(5/42枚)接近完全栓塞,4.8%(2/42枚)不全栓塞。术中共有4例(9.3%)患者出现意外,其中2例(4.7%)出现支架内血栓形成,1例(2.3%)患者术中出现脑血管痉挛,1例(2.3%)患者在栓塞过程中出现支架移位,经调整后恢复理想位置。4例患者经过相应的对症处理后均未出现任何不良后果。造影随访结果:首次造影结果为近全栓塞的2例患者(2枚动脉瘤)未能随访。共有38例(41枚动脉瘤)获得随访,包括单纯置入支架的1例患者,随访造影结果动脉瘤不显影,提示效果良好。其余40枚动脉瘤造影随访结果如下:90%(36/40)完全栓塞,初次随访提示近完全栓塞的1枚动脉瘤后因瘤腔内血栓的进一步机化而获得致密栓塞;5.0%(2/40)接近完全栓塞;5.0%(2/40)不全栓塞。初次治疗造影与随访造影的完全及次全栓塞率无显著差异(P0.05)。临床随访:38例获得临床随访患者的结果依据改良Rankin量表统计为:92.1%(35/38)的患者得分为0~2,7.9%(3/38)的患者得分为3~6。【结论】:颅内宽颈动脉瘤在使用颅内支架结合弹簧圈技术栓塞治疗后疗效肯定,在后期临床疗效观察中也表明了其有可靠的稳定性。
[Abstract]:[objective]: to investigate the characteristics of stent-assisted coils embolization in the treatment of intracranial wide-necked aneurysms, and to evaluate the safety of its clinical efficacy. Feasibility and long-term stability. [methods] Forty patients with intracranial wide-necked aneurysms received stent-assisted coils embolization from April 2012 to January 2015 were included in the study, with 43 aneurysms. All the 40 patients with ruptured aneurysms underwent general anesthesia before operation. The main purpose of this study was to measure the aneurysm neck and the ratio of the tumor body to the aneurysm neck, and to locate the shape of the aneurysm and the adjacent relationship between the aneurysm and the aneurysm. In order to follow up the development of surgery program. The results were recorded by routine radiography after operation and according to Raymond grading scale, so as to analyze and discuss the results of follow-up. Two kinds of follow-up methods were used in this group: imaging follow-up: the patients were followed up at 6 months and 12 months, respectively. The results of the most recent follow-up were recorded with Raymond scale in detail. Then statistical analysis was made between the results of follow-up angiography and that of the first time to compare the changes of the results of the two angiography and to judge whether the embolization effect was stable or not. Clinical follow-up: clinical follow-up was carried out by outpatient service and telephone after operation. Results modified Rankin scale (Mrs) was used to record the results. [results]: 43 wide-necked aneurysms were embolized by stent-assisted coils. 42 of 43 aneurysms were filled with different degrees of tamponade. One case was found that the coil could not enter the aneurysm and only stent was placed in the aneurysm. The results showed that the aneurysms were not developed, indicating satisfactory closure. The initial angiography results of 42 aneurysms without coils in different degrees were: 83. 3% (35 / 42), 11. 9% (5 / 42) close to 4. 8% (2 / 42) of complete embolization. Four patients (9.3%) had an accident during the operation, of which 2 cases (4.7%) had intrastenting thrombosis. 1 case (2.3%) had cerebral vasospasm during the operation, and 1 case (2.3%) had stent displacement during embolization. After adjustment, there were no adverse consequences in the 4 patients who recovered to the ideal position after the corresponding symptomatic treatment. Follow-up results: 2 patients (2 aneurysms) with near total embolism were not followed up. A total of 38 cases (41 aneurysms) were followed-up, including 1 case with simple stenting. The follow-up results of the remaining 40 aneurysms were as follows: 90% (36 / 40) of the aneurysms were completely embolized. The initial follow-up showed that a nearly complete embolization of one aneurysm resulted in a compact embolization of 5.0% (2 / 40) of the aneurysm due to the further organization of the intraluminal thrombus, which was close to 5.0% (2 / 40) of the complete embolization. There was no significant difference in the complete and subtotal embolization rate between the primary and follow-up angiography (P 0.05). The results of clinical follow-up of 38 patients received clinical follow up according to the modified Rankin scale: 92. 1% (35 / 38) of patients scored 0 / 22 / 7.9% (3 / 38) and 3 / 6. [conclusion]: embolization of intracranial wide-necked aneurysms with intracranial stents combined with coil technique After treatment, the curative effect is certain. In the later observation of clinical efficacy, it also showed that it has reliable stability.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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