支架辅助复杂动脉瘤治疗效果与开颅夹闭的对比研究

发布时间：2018-09-17 14:33

【摘要】：目的1.研究支架辅助复杂动脉瘤与显微外科手术治疗复杂动脉瘤的现阶段疗效,分析探讨两类手术治疗效果的优劣点。2.通过对比分析,评估两类治疗的适用情况,为临床复杂动脉瘤患者的治疗提供理论参考。方法回顾我院2012年10月至2016年10月复杂动脉瘤患者的治疗情况,通过术后评估及回访,评价支架辅助复杂动脉瘤与显微外科手术治疗复杂动脉瘤的现阶段疗效。入组标准:1.依据我院内可查的头部CTA、MRA或DSA诊断为颅内动脉瘤;2.颅内动脉瘤经诊断包含瘤体巨大、宽颈、梭形、微小及夹层等的复杂动脉瘤特性,被定性为复杂颅内动脉瘤;3.该动脉瘤于我院经开颅夹闭或介入栓塞手术治疗。排除标准:1.术后患者1年内未于我院复查。2.随访1月后患者失访。通过查阅患者住院病历资料,回顾性分析入组患者的基本信息:性别、年龄、既往病史等;入院时病人WFNS评分、GCS评分、MRS评分;动脉瘤的位置、数目、大小及类别;进行的手术时间、手术方式、围手术期治疗措施和住院时间。通过随访患者及其影像资料,收集病人发现动脉瘤和术后复查的CTA、DSA资料,根据患者身体状况的恢复,依据MRS评分评价患者的术后恢复情况。分析对比两队列的MRS评分获取两种手术疗效的差异。结果在已确定的187例患者,74例采用血管内支架辅助复杂动脉瘤治疗,113采用显微外科开颅夹闭手术治疗。最后一次随访时间平均为179.6天,平均数和中位数时间在血管内支架辅助治疗队列为203.9个和176.5天,在外科手术治疗队列为154天。在年龄、性别、MRS评分、WFNS分级和Fisher分级、中位动脉瘤大小和ICU住院时间方面没有差别。接受动脉瘤开颅夹闭术的患者动脉瘤在大脑中动脉占有有较高比例(37.1%比8.8%;P0.001),在其余位置的动脉瘤比例相对较低(P0.001)。94.7%的动脉瘤夹闭术患者及98.6%的支架辅助动脉瘤栓塞术患者出院回家。首次和最后的随访时改良的Rankin量表评分无明显差别。大部分患者无明显的残疾。血管内介入治疗队列的死亡率为2.7%,外科夹闭队列的死亡率为5.3%;最后随访的死亡率血管内介入治疗为2.7%,外科夹闭术治疗为6.2%(都无明显统计学意义)。血管内治疗到外科手术治疗的转换率为4%。结论复杂动脉瘤的治疗应个体化定制,以血管内支架辅助复杂动脉瘤栓塞术治疗及显微外科开颅夹闭治疗为互补手段。临床应评估患者病情及复杂动脉瘤的特性后,根据这两种治疗技术的优势,给予每位患者选择最佳的治疗方案,以获取最大的收益结果。
[Abstract]:Objective 1. To study the therapeutic effect of stent-assisted complex aneurysm and microsurgical treatment of complex aneurysm, and analyze the advantages and disadvantages of the two types of surgical treatment. 2. Through comparative analysis, the application of the two types of treatment is evaluated to provide a theoretical reference for the treatment of complex aneurysms. Methods the treatment of complex aneurysms in our hospital from October 2012 to October 2016 was reviewed. The therapeutic effects of stent-assisted complex aneurysms and microsurgical procedures were evaluated by postoperative evaluation and return visit. Join the group standard: 1. Intracranial aneurysm was diagnosed by CTA,MRA or DSA in our hospital. Intracranial aneurysms are diagnosed as complex aneurysms with large, wide neck, fusiform, tiny and dissecting features, which are characterized as complex intracranial aneurysms. The aneurysm was clipped or interventional embolized in our hospital. Rule 1. The patients were not reexamined in our hospital within 1 year. The patients were not visited after one month follow-up. By consulting the medical records of the patients, the basic information of the patients were analyzed retrospectively: gender, age, past medical history, WFNS score, Mrs score, location, number, size and type of aneurysms. Time of operation, procedure, perioperative treatment and length of stay. The patients were followed up and their imaging data were collected to collect the CTA,DSA data of finding aneurysms and postoperative reexamination. According to the recovery of the patients' physical condition and the MRS score, the patients' postoperative recovery was evaluated. Analysis and comparison of the two cohorts of MRS score to obtain the difference between the two types of surgical outcomes. Results 74 cases of 187 confirmed patients with complex aneurysms were treated by endovascular stent-assisted complex aneurysm treatment with microsurgical clipping. The mean time of the last follow-up was 179.6 days, the mean and median time were 203.9 and 176.5 days in the endovascular stent adjuvant therapy cohort, and 154 days in the surgical treatment cohort. There was no significant difference in age, gender, Mrs score, WFNS grade and Fisher grade, median aneurysm size and length of stay in ICU. The proportion of aneurysms in the middle cerebral artery (37. 1% vs 8. 8%) was higher in the patients undergoing intracranial clipping (37. 1% vs 8. 8% P0.001). The proportion of aneurysms in the rest of the patients was relatively low (P 0. 001). 94.7% of the patients with aneurysm clipping and 98. 6% of the patients with stent-assisted aneurysm embolization were discharged home. There was no significant difference between the first and last follow-up scores of the modified Rankin scale. Most patients have no significant disability. The mortality of intravascular interventional therapy cohort was 2.7%, the mortality of surgical clipping cohort was 5.3%, the last follow-up mortality was 2.7% in intravascular interventional therapy and 6.2% in surgical clipping (no significant difference). The conversion rate from endovascular treatment to surgical treatment was 4%. Conclusion the treatment of complex aneurysms should be individualized. Endovascular stent-assisted embolization of complex aneurysms and microsurgical clipping are complementary methods. After evaluating the patient's condition and the characteristics of complex aneurysm, each patient should be given the best treatment plan according to the advantages of these two treatment techniques, so as to obtain the most beneficial results.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12

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