CAJ | 학술논문

目的探讨颅内动脉瘤破裂中期(4-10d)血管内栓塞治疗的安全性、技术要点及疗效.方法根据在DSA影像上有无脑血管痉挛(CVS)将全组48例患者分为两组:A组26例为有CVS者,B组22例为无CVS者.全组均在蛛网膜下腔出血(SAH)后4-10d采用可脱性微弹簧圈对破裂性颅内动脉瘤行囊内栓塞.患者均在治疗后3个月时行Glasgow预后评分(COS),治疗结果经,检验.结果全组动脉瘤腔100%闭塞42例,95%闭塞者4例,90%闭塞者2例;其中100%闭塞的患者中A组22例,B组20例,两组完全栓塞率比较差别无统计学意义(χ<'2>=0.43,P>0.05).术中出现与栓塞技术相关的并发症3例.A组GoS:ⅠI级10例,Ⅱ级5例,Ⅲ级7例,Ⅳ级1例,Ⅴ级3例;B组COS:Ⅰ级17例,Ⅱ级3例,Ⅲ级1例,Ⅳ级0例,Ⅴ级1例.全组死亡率8.3%.术后随访3-58个月均无再出血及动脉瘤复发.结论动脉瘤破裂后在中期(4-10d)并不是都伴有CVS;在该期对破裂性颅内动脉瘤采用可脱性弹簧圈进行血管内囊内栓塞安全可行、疗效可靠.
목적 탐토로내동맥류파렬중기(4-10d)혈관내전새치료적안전성、기술요점급료효.방법 근거재DSA영상상유무뇌혈관경련(CVS)장전조48례환자분위량조:A조26례위유CVS자,B조22례위무CVS자.전조균재주망막하강출혈(SAH)후4-10d채용가탈성미탄황권대파렬성로내동맥류행낭내전새.환자균재치료후3개월시행Glasgow예후평분(COS),치료결과경,검험.결과 전조동맥류강100%폐새42례,95%폐새자4례,90%폐새자2례;기중100%폐새적환자중A조22례,B조20례,량조완전전새솔비교차별무통계학의의(χ<'2>=0.43,P>0.05).술중출현여전새기술상관적병발증3례.A조GoS:ⅠI급10례,Ⅱ급5례,Ⅲ급7례,Ⅳ급1례,Ⅴ급3례;B조COS:Ⅰ급17례,Ⅱ급3례,Ⅲ급1례,Ⅳ급0례,Ⅴ급1례.전조사망솔8.3%.술후수방3-58개월균무재출혈급동맥류복발.결론 동맥류파렬후재중기(4-10d)병불시도반유CVS;재해기대파렬성로내동맥류채용가탈성탄황권진행혈관내낭내전새안전가행、료효가고.
Objective To investigate the security, main technical points and curative effect of endovascular embolization in medium-term of ruptured intraeranial aneurysms. Method Aeeording to digital subtraction arteriography, all of the 48 cases were divided into two groups: A was 26 cases with cerebral vasospasm and B 22 cases without cerebral vasospasm. All cases with raptured intraeranial aneurysms were embolizecl 4-10 days after subaruehnoid hemorrhage with detachable micro-coils. Patients were all scored with Glasgow Outcome Scale 3 months after surgery. The therapeutie result was tested by χ2.Results Of the 48 raptured intracranial aneurysms, 42 cases were 100 % occluded, 4 cases 95 %occluded, and 2 cases 90 % occluded. The number of complete embolization cases in group A were 22 and in group B 20. There was not significant difference between the two groups in complete embolism rate(χ2 =0.43 ,P > 0. 05 ) o During the operation, 3 cases happened technique-related complications. According to the Glasgow prognosis score, the therapeutic efficacy in group A was that: 10 patients were in grade Ⅰ , 5 ingrade Ⅱ , 7 in grade Ⅲ, 1 in grade Ⅳ, and 3 in grade Ⅴ ; and in group B: 17 patients were in grade I , 3in grade Ⅱ , 1 in grade Ⅲ, 0 in grade Ⅳ, and 1 in grade Ⅴ. The mortality rate in all cases was 8.3%.None was rebreeding and recidivism follow-up 3 to 58 months after operation. Conclusions Not all raptured intracranial aneurysms have cerebral vasospasm in medium-term (4-10 days after SAH ). It is safe and reliable to embolize the ruptured intracranial aneurysm with detachable micro-coils in this period.