摘要
目的探讨介入性血管内栓塞术(SIAE)治疗破裂颅内动脉瘤的临床疗效及安全性。方法选择我院2017年2月~2019年1月期间收治的颅内动脉瘤破裂患者84例。根据患者不同手术方式将其分为对照组和观察组。观察组采用SIAE治疗,对照组采用常规开颅夹闭术治疗。比较两组手术指标、住院情况,手术前后Hunt-Hess分级变化,术后3个月mRS分级情况,手术前、术后24 h血清NSE、S100β水平变化及术后并发症发生情况。结果观察组手术时间、术中出血量及住院时间均少于对照组,治疗费用高于对照组(P<0.001);两组术后Hunt-Hess分级均明显改善(P<0.05),组间Hunt-Hess分级比较差异无统计学意义(P>0.05);两组术后3个月mRS分级情况、预后良好率(对照组85.71%:观察组88.10%)比较差异无统计学意义(P>0.05);两组术后24h血清NSE、S100β水平均升高,观察组血清NSE、S100β水平升高幅度小于对照组(P<0.001);两组术后感染、破裂再出血、脑积水、脑血管痉挛及脑梗死等并发症比较差异无统计学意义(P>0.05)。结论SIAE对颅内动脉瘤破裂患者的疗效与传统开颅夹闭术相当,均为安全、有效的治疗手段,相较于开颅夹闭术,SIAE的手术时间短、术中出血量少、住院时间短、手术对脑组织损伤较小,但治疗费用较高,临床推广存在一定难度。
Objective To investigate the clinical efficacy and safety of superselective intra-arterial embolization(SIAE)in the treatment of ruptured intracranial aneurysms.Methods 84 patients with ruptured intracranial aneurysms admitted to our hospital from February 2017 to January 2019 were selected.The patients were divided into control group and observation group according to different surgical methods.The observation group was treated with SIAE,and the control group with conventional craniotomy.The changes of hunt Hess grade before and after operation,Mrs grade 3 months after operation,serum NSE and S100βlevels before and 24 hours after operation,and postoperative complications were compared.Results The operation time,intraoperative hemorrhage and hospitalization time of the observation group were less than those of the control group,and the treatment cost was higher than that of the control group(P<0.001);the hunt Hess grading of the two groups was significantly improved after operation(P<0.05),and there was no significant difference between the two groups in hunt Hess grading(P>0.05);the mRS grading and the good prognosis rate of the two groups in three months after operation(85.71%of the control group:88.10%of the observation group)had no difference The levels of NSE and S100βin the observation group were lower than those in the control group(P<0.001);there was no significant difference between the two groups in postoperative complications such as infection,rebleeding,hydrocephalus,cerebral vasospasm and cerebral infarction(P>0.05).Conclusion SIAE is a safe and effective treatment for patients with ruptured intracranial aneurysms.Compared with open craniotomy,SIAE has shorter operation time,less intraoperative bleeding,shorter hospitalization time and less brain tissue damage,but the cost of treatment is higher,so it is difficult to promote clinical application.
作者
袁明智
牛国栋
任洪波
Yuan Mingzhi;Niu Guodong;Ren Hongbo(The third Departmentof Neurology,Handan Central Hospital,056008)
出处
《立体定向和功能性神经外科杂志》
2019年第6期347-351,共5页
Chinese Journal of Stereotactic and Functional Neurosurgery
关键词
介入性血管内栓塞术
开颅夹闭术
颅内动脉瘤
脑损伤
临床疗效
Superselective intra-arterial embolization
Transcranial clipping
Intracranial aneurysm
Brain injury
Clinical efficacy
作者简介
通讯作者:任洪波,rhb68@126.com
