摘要
目的比较显微手术夹闭与血管内介入栓塞术治疗大脑中动脉动脉瘤破裂的临床疗效及安全性,为临床治疗提供理论依据。方法纳入2012年6月至2015年8月四川省简阳市人民医院和北京天坛医院60例大脑中动脉动脉瘤破裂患者作为前瞻性研究对象,采用随机数字表法分为观察组和对照组,每组各30例。观察组采用显微手术夹闭治疗,对照组采用血管内介入栓塞术治疗。比较两组手术一般情况、并发症发生情况、术后1个月改良Rankin量表评分和1年随访情况。结果观察组患者手术时间、术后住院时间均长于对照组,术中出血量多于对照组,差异具有统计学意义(P<0.05)。两组患者动脉瘤术中破裂、脑梗死、血管痉挛、脑积水及感染等并发症发生率比较,差异均无统计学意义(P>0.05)。术后1个月,观察组患者改良Rankin量表评分结果明显优于对照组,差异具有统计学意义(P<0.05)。术后1年,观察组患者动脉瘤消失率、复发率及GOS评分分级优良率分别为86.21%、3.45%及82.76%,均优于对照组,差异具有统计学意义(P<0.05)。结论血管内介入栓塞术治疗大脑中动脉动脉瘤破裂手术创伤小,但是采用显微手术夹闭治疗的患者近期及远期神经功能恢复好,术后动脉瘤消失率高、残留稳定。
Objective To compare the safety and clinical efficacy between microsurgical clipping and endovascular coiling in treatment of ruptured aneurysm of middle cerebral artery,and to provide theoretic foundations of clinical treatment. Methods 60 patients with ruptured middle cerebral artery aneurysm in our hospital from June 2012 to August 2015 were selected as the research objects,the patients were divided into the observation group and the control group by random number table,30 cases in each group. The patients of the observation group used microsurgical clipping,while the patients of the control group used endovascular coiling. The general operation,complications,the modified Rankin scale scores in 1 mouth after operation and follow-up of 1 years after operation were compared between the two groups. Results The patients of the observation group had significantly longer operative time and postoperative length of stay and significantly greater intra-operative blood loss than the control group（ P〈0. 05）. The patients of the two groups had insignificantly different incidences of complications such as intra-operative rupture of aneurysm,cerebral infarction,angiospasm,hydrocephalus,and infection（ P〉0. 05）. At one month after the surgeries,the observation group had significantly better result of modified Rankin scale score than the control group（ P〈0. 05）. The rates of aneurysm disappearance,the relapse and the scores of GOS at one year after the surgeries in observation group were 86. 21%,3. 45% and 82. 76%,which were significantly better than those of the control group（ P〈0. 05）. Conclusion Endovascular coiling in treatment of ruptured aneurysm of middle cerebral artery has smaller operation wound,while microsurgical clipping in treatment of the disease has better short-term and long-term nerve function recovery,higher rate of postoperative aneurysm disappearance,and more stable residual.
作者
徐建
刘佰运
XU Jian;LIU Bai - yun(Department of Neurosurgery,The People＇s Hospital of Jianyang,Jianyang Sichuan 641400,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China.)
出处
《临床和实验医学杂志》
2018年第16期1751-1754,共4页
Journal of Clinical and Experimental Medicine
基金
北京科技计划重大项目科研课题资金资助项目(编号201502309)
