摘要
目的对比早期显微手术夹闭与血管介入栓塞治疗前循环不同部位颅内破裂动脉瘤的疗效。方法回顾性分析280例前循环颅内破裂动脉瘤患者资料,依据治疗方案不同分为夹闭组(应用显微夹闭手术治疗,n=142)与栓塞组(应用血管介入栓塞术治疗,n=138)。采用倾向性匹配法,以0.25为卡钳值、按1:1比例筛选出120对基线资料可比的患者,比较两组患者基线资料、围手术期指标、并发症及预后情况;再按动脉瘤部位:前交通动脉、后交通动脉和大脑中动脉,对有统计学意义的指标进行分层分析。结果夹闭组前交通动脉、后交通动脉和大脑中动脉手术时间、术中出血量和住院时间均高于栓塞组,差异均具有统计学意义(均P<0.001)。夹闭组和栓塞组并发症差异无统计学意义(均P>0.05)。夹闭组和栓塞组术后1年瘤颈残留率分别为7.50%(9/120)和47.50%(57/120),其中前交通动脉瘤颈残留率分别为2.50%(3/120)和15.00%(18/120),后交通动脉瘤颈残留率分别为2.50%(3/120)和15.00%(18/120),大脑中动脉瘤颈残留率分别为2.50%(3/120)和17.50%(21/120),两组差异具有统计学意义(均P<0.05)。夹闭组和栓塞组术后1年预后良好率分别为82.50%(99/120)和90.00%(108/120),差异无统计学意义(P>0.05)。术后1年动脉瘤复发率:两组前交通动脉分别为6.25%(3/48)和26.67%(12/45),两组后交通动脉分别为7.14%(3/42)和26.67%(12/45),两组大脑中动脉分别为0(0/30)和30.00%(9/30),差异无统计学意义(均P>0.05)。结论针对不同部位前循环颅内破裂动脉瘤,采用显微夹闭术可降低瘤颈残留率且动脉瘤复发率较低,采用血管介入栓塞术有利于提升患者康复速度(围手术期指标更优),两种手术方案均可有效改善患者预后。
Objective To compare the efficacy of early microsurgical clipping and endovascular embolization in the treatment of ruptured intracranial aneurysms at different locations in the anterior circulation.Methods The clinical data of 280 patients with ruptured anterior circulation aneurysms were analyzed retrospectively.Based on the treatment plan,the patients were divided into a clipping group(treated with microsurgical clipping,n=142)and an embolization group(treated with endovascular embolization,n=138).The propensity score matching(PSM)was performed with a caliper value of 0.25 and a 1:1 matching ratio,120 pairs of patients with comparable baseline data were selected.Baseline data,perioperative indicators,complications,and prognosis were compared between the two groups.Stratified analysis was then performed on statistically significant indicators according to aneurysm location:anterior communicating artery,posterior communicating artery,and middle cerebral artery.Results The clipping group had longer operation times,greater intraoperative blood loss,and longer hospital stays for aneurysms in the anterior communicating artery,posterior communicating artery,and middle cerebral artery compared to the embolization group,with statistically significant differences(all P<0.001).There was no statistically significant difference in complications between the clipping and embolization groups(P>0.05).The residual rates of aneurysmal neck at one year postoperatively were 7.50% and 47.50% in the clipping and embolization groups,respectively,with rates of 2.50% and 15.00% for anterior communicating artery aneurysms,2.50% and 15.00% for posterior communicating artery aneurysms,and 2.50% and 17.50% for middle cerebral artery aneurysms,respectively,all showing statistically significant differences(all P<0.05).The rates of good prognosis at one year postoperatively were 82.50% and 90.00% in the clipping and embolization groups,respectively,with no statistically significant difference(P>0.05).The aneurysm recurrence rates at one year postoperatively were 6.25%(3/48)and 26.67%(12/45)for anterior communicating artery aneurysms,7.14%(3/42)and 26.67%(12/45)for posterior communicating artery aneurysms,and 0.00%(0/30)and 30.00%(9/30)for middle cerebral artery aneurysms in the two groups,respectively,with no statistically significant differences(all P>0.05).Conclusions For anterior circulation ruptured intracranial aneurysms at different locations,microsurgical clipping can reduce the rate of aneurysm neck residue and is associated with a lower recurrence rate,while endovascular embolization facilitates faster patient recovery(with superior perioperative indicators).Both surgical approaches can effectively improve patient prognosis.
作者
刘玲
张继东
Liu Ling;Zhang Jidong(Department of Neurosurgery,Nanyang Nanshi Hospital,Nanyang,Henan 473000,China)
出处
《中国微侵袭神经外科杂志》
2025年第8期474-479,共6页
Chinese Journal of Minimally Invasive Neurosurgery
关键词
颅内动脉瘤
破裂
蛛网膜下腔出血
显微夹闭手术
血管介入栓塞术
intracranial aneurysm,ruptured
subarachnoid hemorrhage
microsurgical clipping
endovascular embolization
