CAJ | 학술논문

目的：比较开颅夹闭术与血管内介入动脉瘤栓塞术治疗中青年高危颅内动脉瘤破裂的效果。方法选择2011年4月—2014年3月在承德医学院附属医院神经外科接受治疗的中青年高危颅内动脉瘤破裂患者94例，根据手术指征和患者情况分为A组53例和B组41例。 A组患者采用开颅夹闭术治疗， B组患者采用血管内介入动脉瘤栓塞术治疗。比较两组患者手术前后Hunt－Hess分级、术后3个月Rankin量表评分、术后并发症情况及住院情况（包括住院时间、医疗费用）。结果两组患者手术前后Hunt－Hess分级、术后3个月Rankin量表评分及术后并发症发生率比较，差异无统计学意义（P＞0.05）； A组患者住院时间长于B组，医疗费用低于B组（P＜0.05）。结论开颅夹闭术和血管内介入动脉瘤栓塞术治疗中青年高危颅内动脉瘤均有良好的治疗效果，开颅夹闭术是多发性动脉瘤、颅内血肿形成、载瘤动脉解剖位置较复杂、瘤体较大患者的首选方案；而血管内介入动脉瘤栓塞术更适用于年龄较大、手术耐受力差、瘤体位置较深患者。
목적：비교개로협폐술여혈관내개입동맥류전새술치료중청년고위로내동맥류파렬적효과。방법선택2011년4월—2014년3월재승덕의학원부속의원신경외과접수치료적중청년고위로내동맥류파렬환자94례，근거수술지정화환자정황분위A조53례화B조41례。 A조환자채용개로협폐술치료， B조환자채용혈관내개입동맥류전새술치료。비교량조환자수술전후Hunt－Hess분급、술후3개월Rankin량표평분、술후병발증정황급주원정황（포괄주원시간、의료비용）。결과량조환자수술전후Hunt－Hess분급、술후3개월Rankin량표평분급술후병발증발생솔비교，차이무통계학의의（P＞0.05）； A조환자주원시간장우B조，의료비용저우B조（P＜0.05）。결론개로협폐술화혈관내개입동맥류전새술치료중청년고위로내동맥류균유량호적치료효과，개로협폐술시다발성동맥류、로내혈종형성、재류동맥해부위치교복잡、류체교대환자적수선방안；이혈관내개입동맥류전새술경괄용우년령교대、수술내수력차、류체위치교심환자。
Objective To compare the clinical effect in treating young and middle-aged patients with high-risk ruptured intracranial aneurism between craniotomy clipping and endovascular intervention aneurysm embolization.Methods From April 2011 to March 2014, a total of 94 young and middle-aged patients with high-risk ruptured intracranial aneurism were selected in the Department of Neurosurgery, the Affiliated Hospital of Chengde Medical College, and they were divided into A group ( n=53 ) and B group ( n=41 ) according to surgical indication and individual situation.Patients of A group were treated by craniotomy clipping, while patients of B group were treated by endovascular intervention aneurysm embolization.Hunt-Hess grade before and after surgery, Rankin scale score after 3 months of surgery, incidence of postoperative complications, hospital stays and medical expenses were compared between the two groups.Results No statistically significant differences of Hunt-Hess grade was found between the two groups before or after surgery, nor was Rankin scale score after 3 months of surgery or incidence of postoperative complications between the two groups ( P >0.05 ); hospital stays of A group was statistically significantly longer than that of B group, while medical expenses of A group was statistically significantly less than that of B group (P<0.05).Conclusion Both of craniotomy clipping and endovascular intervention aneurysm embolization have certain clinical effect in treating young and middle-aged patients with high-risk ruptured intracranial aneurism; craniotomy clipping is the first choice of patients with multiple aneurysms, intracranial hematoma formation, complex anatomical position of parent artery and relatively large aneurysm, while endovascular intervention aneurysm embolization is applicative in the patients with advanced age, poor surgery tolerance and deep-location aneurysm.