中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
20期
16-19
,共4页
樊庆荣%王恩任%张列%邱治春%何明杰
樊慶榮%王恩任%張列%邱治春%何明傑
번경영%왕은임%장렬%구치춘%하명걸
颅内动脉瘤%复发%手术夹闭%血管内介入治疗
顱內動脈瘤%複髮%手術夾閉%血管內介入治療
로내동맥류%복발%수술협폐%혈관내개입치료
Intracranial aneurysm%Recurrence%Surgical clipping%Intravascular interventional therapy
目的 对比观察手术夹闭和血管内介入治疗颅内宽颈动脉瘤的临床疗效和安全性.方法 回顾性分析2010年2月至2013年2月收治的158例颅内宽颈动脉瘤患者的临床资料,其中手术夹闭治疗92例(手术夹闭组),血管内介入治疗66例(血管内介入组),比较两组术后疗效、治疗时间、住院时间、住院费用及术后并发症情况,随访10～ 46个月,比较两组复发情况.结果 手术夹闭组疗效良好率与不良率分别为90.2％(83/92)和9.8％ (9/92),血管内介入组分别为90.9％(60/66)和9.1％(6/66),两组比较差异无统计学意义(x2=0.298,P＞0.05).两组患者在术前Hunt-Hess分级及CT Fisher分级比较差异无统计学意义(P＞0.05);出院6个月后,两组患者均采用mRS评分行疗效评价,相同级别患者的疗效不良率在两种治疗方式间比较差异无统计学意义(P＞0.05).手术夹闭组的治疗时间、住院时间均显著长于血管内介入组[(4.03±1.01)h比(1.61±0.98)h、(15.90±2.03)d比(13.20± 1.95)d],住院费用显著低于血管内介入组[61 829.4±320.6)元比(99 876.2±371.5)元],差异均有统计学意义(P＜0.05).两组术后并发症发生率比较差异无统计学意义(P＞0.05).术后平均随访31.3(10～46)个月,手术夹闭组复发率为1.1％(1/94),显著低于血管内介入组的8.8％(6/68),差异有统计学意义(P＜0.05).结论 手术夹闭和血管内介入治疗颅内宽颈动脉瘤均具有不同的特点,因此对患者治疗时,应根据患者的术前状态(尤其是术前Hunt-Hess和Fisher分级)以及患者自身经济状况等选择不同的治疗方式.
目的 對比觀察手術夾閉和血管內介入治療顱內寬頸動脈瘤的臨床療效和安全性.方法 迴顧性分析2010年2月至2013年2月收治的158例顱內寬頸動脈瘤患者的臨床資料,其中手術夾閉治療92例(手術夾閉組),血管內介入治療66例(血管內介入組),比較兩組術後療效、治療時間、住院時間、住院費用及術後併髮癥情況,隨訪10～ 46箇月,比較兩組複髮情況.結果 手術夾閉組療效良好率與不良率分彆為90.2％(83/92)和9.8％ (9/92),血管內介入組分彆為90.9％(60/66)和9.1％(6/66),兩組比較差異無統計學意義(x2=0.298,P＞0.05).兩組患者在術前Hunt-Hess分級及CT Fisher分級比較差異無統計學意義(P＞0.05);齣院6箇月後,兩組患者均採用mRS評分行療效評價,相同級彆患者的療效不良率在兩種治療方式間比較差異無統計學意義(P＞0.05).手術夾閉組的治療時間、住院時間均顯著長于血管內介入組[(4.03±1.01)h比(1.61±0.98)h、(15.90±2.03)d比(13.20± 1.95)d],住院費用顯著低于血管內介入組[61 829.4±320.6)元比(99 876.2±371.5)元],差異均有統計學意義(P＜0.05).兩組術後併髮癥髮生率比較差異無統計學意義(P＞0.05).術後平均隨訪31.3(10～46)箇月,手術夾閉組複髮率為1.1％(1/94),顯著低于血管內介入組的8.8％(6/68),差異有統計學意義(P＜0.05).結論 手術夾閉和血管內介入治療顱內寬頸動脈瘤均具有不同的特點,因此對患者治療時,應根據患者的術前狀態(尤其是術前Hunt-Hess和Fisher分級)以及患者自身經濟狀況等選擇不同的治療方式.
목적 대비관찰수술협폐화혈관내개입치료로내관경동맥류적림상료효화안전성.방법 회고성분석2010년2월지2013년2월수치적158례로내관경동맥류환자적림상자료,기중수술협폐치료92례(수술협폐조),혈관내개입치료66례(혈관내개입조),비교량조술후료효、치료시간、주원시간、주원비용급술후병발증정황,수방10～ 46개월,비교량조복발정황.결과 수술협폐조료효량호솔여불량솔분별위90.2％(83/92)화9.8％ (9/92),혈관내개입조분별위90.9％(60/66)화9.1％(6/66),량조비교차이무통계학의의(x2=0.298,P＞0.05).량조환자재술전Hunt-Hess분급급CT Fisher분급비교차이무통계학의의(P＞0.05);출원6개월후,량조환자균채용mRS평분행료효평개,상동급별환자적료효불량솔재량충치료방식간비교차이무통계학의의(P＞0.05).수술협폐조적치료시간、주원시간균현저장우혈관내개입조[(4.03±1.01)h비(1.61±0.98)h、(15.90±2.03)d비(13.20± 1.95)d],주원비용현저저우혈관내개입조[61 829.4±320.6)원비(99 876.2±371.5)원],차이균유통계학의의(P＜0.05).량조술후병발증발생솔비교차이무통계학의의(P＞0.05).술후평균수방31.3(10～46)개월,수술협폐조복발솔위1.1％(1/94),현저저우혈관내개입조적8.8％(6/68),차이유통계학의의(P＜0.05).결론 수술협폐화혈관내개입치료로내관경동맥류균구유불동적특점,인차대환자치료시,응근거환자적술전상태(우기시술전Hunt-Hess화Fisher분급)이급환자자신경제상황등선택불동적치료방식.
Objective To compare the clinical effects and safety of surgical clipping and intravascular interventional therapy in treatment of intracranial wide-necked aneurysm.Methods The clinical data of 158 patients with intracranial wide-necked aneurysm from February 2010 to February 2013 were retrospectively analyzed,all patients were divided into two groups:surgical clipping group with 92 cases and intravascular interventional therapy group with 66 cases,the postoperative curative effects,treatment time,hospital stay,hospital expenses and postoperative complications between two groups were compared.Followed up for 10-46 months,the recurrence rate were compared.Results The good prognosis and defective rates between surgical clipping group and intravasular interventional therapy group had no significant difference [90.2％(83/92) vs.90.9％(60/66),9.8％(9/92) vs.9.1％ (6/66)] (x2 =0.298,P ＞ 0.05).The preoperative Hunt-Hess classification and CT Fisher classification between two groups had no significant difference (P ＞ 0.05).Six months after discharge,mRS score was used to evaluate the curative effect,the defective rates in same level patients between two kinds of treatment methods had no significantdifference (P ＞ 0.05).The treatment time,hospital stay in surgical clipping group were significantly longer than those in intravascular interventional therapy group [(4.03 ± 1.01) h vs.(1.61 ± 0.98) h,(15.90 ± 2.03) dvs.(13.20 ± 1.95) d],hospital expenses was significantly lower than that in intravascular intervention therapy group [61 829.4 ±320.6) yuan vs.(99 876.2 ±371.5) yuan] (P ＜0.05).The postoperative complications rate between two groups had no significant difference (P ＞ 0.05).Followed up for 31.3 (10-46) months,the recurrence rate in surgical clipping group was significantly lower than that in intravascular intervention therapy group [1.1％ (1/94) vs.8.8％ (6/68)] (P ＜ 0.05).Conclusion Surgical clipping and intravascular interventional therapy in treatment of intracranial wide-necked aneurysm has their own different characteristics,so patients' treatment methods should be based on their preoperative status (especially preoperative Hunt-Hess and Fisher classification) and patients' economic conditions.
