CAJ | 학술논문

目的探讨多层螺旋CT血管造影(MS-CTA)能否作为动脉瘤显微夹闭术前首选和唯一的评估指标.方法回顾性分析2008年1月至2010年10月在浙江省人民医院完成的动脉瘤显微夹闭手术105例,其中39例术前行64排或320排螺旋CTA检查(CTA组),21例患者术前同时行CTA和DSA检查,45例术前行DSA检查(DSA组).比对CTA组CTA影像和夹闭术中显示的动脉瘤大小、形态、瘤颈宽度和周围重要血管分支信息,并评价二者的一致性.比较分析CTA组和DSA组的手术并发症率和出院时的格拉斯哥预后评分(GOS评分).患者的临床基线资料使用t检验、卡方检验或秩和检验;CTA和手术对动脉瘤的评价使用Kappa一致性检验;两组的手术并发症和出院GOS评分比较使用等级秩和检验.结果 CTA组39例患者中37例患者成功夹闭动脉瘤,1例因动脉瘤颈暴露困难改为介入栓塞治疗,1例在去骨瓣后动脉瘤破裂仅行开窗减压术.MS-CTA在动脉瘤大小、瘤颈最示方面和手术结果的一致性较好(κ=0.726,κ=0.756),在动脉瘤形态和对周围重要血管分支的显示方面和手术结果的一致性一般(κ=0.524,κ=0.473),CTA组和DSA组患者手术并发症率(P=0.509)和出院时两者GOS评分(P=0.239)差异无统计学意义.结论 MS-CTA能够清楚显示动脉瘤各项重要特征,可作为动脉瘤外科显微夹闭术前首选和唯一的术前评估方法.
목적 탐토다층라선CT혈관조영(MS-CTA)능부작위동맥류현미협폐술전수선화유일적평고지표.방법 회고성분석2008년1월지2010년10월재절강성인민의원완성적동맥류현미협폐수술105례,기중39례술전행64배혹320배라선CTA검사(CTA조),21례환자술전동시행CTA화DSA검사,45례술전행DSA검사(DSA조).비대CTA조CTA영상화협폐술중현시적동맥류대소、형태、류경관도화주위중요혈관분지신식,병평개이자적일치성.비교분석CTA조화DSA조적수술병발증솔화출원시적격랍사가예후평분(GOS평분).환자적림상기선자료사용t검험、잡방검험혹질화검험;CTA화수술대동맥류적평개사용Kappa일치성검험;량조적수술병발증화출원GOS평분비교사용등급질화검험.결과 CTA조39례환자중37례환자성공협폐동맥류,1례인동맥류경폭로곤난개위개입전새치료,1례재거골판후동맥류파렬부행개창감압술.MS-CTA재동맥류대소、류경최시방면화수술결과적일치성교호(κ=0.726,κ=0.756),재동맥류형태화대주위중요혈관분지적현시방면화수술결과적일치성일반(κ=0.524,κ=0.473),CTA조화DSA조환자수술병발증솔(P=0.509)화출원시량자GOS평분(P=0.239)차이무통계학의의.결론 MS-CTA능구청초현시동맥류각항중요특정,가작위동맥류외과현미협폐술전수선화유일적술전평고방법.
Objective To evaluate if MS-CTA can be the primary and sole evaluative criteria for the treatment of intracranial aneurysms by microsurgery clipping. Methods Between January 2008 and October 2010, 105 patients with intracranial aneurysm underwent microsurgery clipping in our institution were respectively analyzed, out of which 39 patients with preoperative MS-CTA (64- or 320-slice CT scanner) examinations (MS-CTA group) , 21 with MS-CTA combined with DSA and 45 with DSA ( DSA group). The aneurismal size, neck, morphous and peripheral branches were compared between the CTA data and operative results, and the concordance between which were analyzed. The rate of operative complication and the GOS scale at discharge were also compared between MS-CTA group and DSA group. t test, Chi-Square test or Rank test were used for analysis of the patients' baseline data, Kappa test for the concordance between MS-CTA and operative results, Kruskal-Wallis test for operative complication and Mann-whitney test for the GOS at discharge between MS-CTA group and DSA group. Results Thirty-seven patients out of the MS -CTA group obtained successful microsurgery clipping, with 1 transferred to coil embolization because of the difficulty in exposing the aneurismal neck and 1 to decompressive craniectomy because of aneurismal rebleeding at removal cranium. There was a good concordance between MS-CTA and operative results on depicting aneurysmal size and neck ( κ =0.726 ,κ =0. 756) and a ordinary concordance on morphous and peripheral branches ( κ =0.524, κ =0.473). There was no significant difference on the rate of operative complication (P =0.509) and GOS scale (P =0.239) at discharge. Conclusions MS-CTA can reveal the important characteristics of intracranial aneurysms, and has a high safety as being the primary and sole criteria before microsurgery clipping.