本文關(guān)鍵詞： 顱內(nèi)小動(dòng)脈瘤(≤4mm) 介入栓塞 開顱夾閉　出處：《延安大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:回顧性分析介入栓塞及開顱手術(shù)治療顱內(nèi)破裂小動(dòng)脈瘤(≤4mm)臨床預(yù)后結(jié)果,比較兩種治療方法的療效,探討兩種治療方法的優(yōu)缺點(diǎn),為臨床醫(yī)學(xué)實(shí)踐操作及科學(xué)研究提供相關(guān)的理論依據(jù)。方法:1.研究對(duì)象收集2010年10月至2015年10月期間就診于廣州軍區(qū)武漢總醫(yī)院的顱內(nèi)破裂小動(dòng)脈瘤(≤4mm)患者共511例,其中介入栓塞組261例,開顱手術(shù)治療組250例。入選標(biāo)準(zhǔn):(1).經(jīng)CT或腰椎穿刺證實(shí)SAH;(2).雙平板DSA機(jī)3D旋轉(zhuǎn)血管成像術(shù)確診最大動(dòng)脈瘤直徑≤4mm;(3).多發(fā)動(dòng)脈瘤患者,主要由小動(dòng)脈瘤導(dǎo)致的蛛網(wǎng)膜下腔出血。所有患者治療前均經(jīng)過本院神經(jīng)外科及介入醫(yī)師術(shù)前討論,患者本人或家屬簽署知情同意書。2.主要設(shè)備及技術(shù)德國西門子公司Artis zee biplane雙平板DSA機(jī),System syngo X-WP三維后處理系統(tǒng),常規(guī)DSA圖像采集,經(jīng)頸內(nèi)動(dòng)脈、頸外動(dòng)脈、椎動(dòng)脈分別給與造影劑,頸內(nèi)動(dòng)脈3ml/s,總量18ml,椎動(dòng)脈2.5ml/s,總量15ml,采用“5sDSA模式”,圖像自動(dòng)傳輸至三維后處理系統(tǒng)進(jìn)行測(cè)量動(dòng)脈瘤大小及了解動(dòng)脈瘤部位。3.統(tǒng)計(jì)學(xué)方法采用SPSS19.0統(tǒng)計(jì)軟件,計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(X±S)表示,計(jì)數(shù)資料以百分比表示。組間比較用T檢驗(yàn)、分類資料行卡方檢驗(yàn)(或Fisher確切概率分析),多個(gè)樣本非參數(shù)檢驗(yàn)秩和檢驗(yàn)采用Kruskal-Wallis。檢驗(yàn)水準(zhǔn)為α=0.05,檢驗(yàn)水平為P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果:介入栓塞組261例,性別:男105(40.0%)例,女156(60.0%)例,年齡52.65±10.4歲,既往吸煙史40(15.3%)例,高血壓史118(45.2%)例,冠心病史9(3.4%)例,糖尿病史16(6.1%)例,術(shù)前出現(xiàn)腦積水39(14.9%)例,發(fā)病到治療時(shí)間2.69±4.7天,入院時(shí)hunt-hess分級(jí)1-3級(jí)214(82.1%)例,4-5級(jí)47(17.9%)例,fisher分級(jí)0-2級(jí)165(63.2%)例,3-4級(jí)96(36.8%)例,動(dòng)脈瘤位于前循環(huán)240(92%)例,后循環(huán)21(8%)例,窄頸67(25.7%)例,寬頸194(74.3%)例。開顱夾閉共250例,性別:男96(38.4%),女154(61.6%),年齡52.79±9.6歲,既往吸煙史37(14.8%)例,高血壓史101(40.4%)例,冠心病史8(3.2%)例,糖尿病史10(4.0%)例,術(shù)前出現(xiàn)腦積水37(14.8%)例,發(fā)病到治療時(shí)間2.52±3.6天,入院時(shí)hunt-hess分級(jí)1-3級(jí)192(76.8%)例,4-5級(jí)58(23.2%)例,fisher分級(jí)0-2級(jí)150(60.0%)例,3-4級(jí)100(40%)例,動(dòng)脈瘤位于前循環(huán)234(93.6%)例,后循環(huán)16(6.4%)例,窄頸88(35.2%)例,寬頸162(64.8%)例。臨床結(jié)果1年回訪介入組良好(mrs0-2分)187例(71.6%)、殘疾(mrs3-5分)68例(26.1%,)、死亡(mrs6分)6例(2.3%)。開顱夾閉組1年回訪良好(mrs0-2分)171例(68.4%)、殘疾(mrs3-5分)74例(29.6%,)、死亡(mrs6分)5例(2.0%)。介入組1年內(nèi)復(fù)發(fā)6例(2.3%),夾閉組1年內(nèi)復(fù)發(fā)8例(3.1%)。兩組治療預(yù)后在統(tǒng)計(jì)學(xué)上無差異。兩組患者住院期間平均花費(fèi)介入治療組120527.5±48152.7元,開顱夾閉組121985±55070.4元,兩組統(tǒng)計(jì)無明顯差異,患者住院平均天數(shù)介入組16.99±10.8天,開顱夾閉組21.1±11.6天,兩組統(tǒng)計(jì)分析(p0.05),兩組數(shù)值在統(tǒng)計(jì)學(xué)存在明顯差異。結(jié)論:目前顱內(nèi)破裂小動(dòng)脈瘤(≤4mm)的主要治療方法是開顱夾閉及介入栓塞兩種,而且目前多數(shù)臨床中心主張介入栓塞治療。我們的研究發(fā)現(xiàn):從短期研究分析,介入栓塞與開顱夾閉對(duì)于顱內(nèi)破裂小動(dòng)脈瘤的治療只有在住院時(shí)間有差異,其它評(píng)估資料中:住院手術(shù)花費(fèi)、術(shù)后恢復(fù)情況、術(shù)中并發(fā)癥及術(shù)后并發(fā)癥等各項(xiàng)評(píng)估指標(biāo)在兩組之間均無統(tǒng)計(jì)學(xué)差異。對(duì)此,我們總結(jié)以下幾點(diǎn):1.介入栓塞在顱內(nèi)小動(dòng)脈瘤的治療中,隨著介入技術(shù)及材料學(xué)的發(fā)展,手術(shù)的安全性較開顱手術(shù)無明顯差異;2.介入栓塞因其手術(shù)創(chuàng)傷小,術(shù)后恢復(fù)快,將被越來越多的醫(yī)務(wù)人員及患者所接受;3.因其動(dòng)脈瘤體積小,兩種手術(shù)治療費(fèi)用上無明顯差異,這使得在經(jīng)濟(jì)上困難的患者可以優(yōu)先選擇介入治療;4.支架技術(shù)的使用在小動(dòng)脈瘤的治療中較其它類型動(dòng)脈瘤多,因其隨訪時(shí)間短,對(duì)于其遠(yuǎn)期影響需要長期觀察。總之,介入栓塞手術(shù)在未來小動(dòng)脈瘤的治療中將占主導(dǎo)地位,在治療選擇中應(yīng)優(yōu)先考慮。
[Abstract]:Objective: To retrospectively analyze the interventional embolization and craniotomy for treatment of ruptured intracranial aneurysms (4mm) clinical outcome, the curative effect of two treatment methods, advantages and disadvantages of two kinds of treatment methods, for the clinical practice and scientific research operations provide relevant theoretical basis. Methods: 1. intracranial research object from October 2010 to during October 2015 in Wuhan General Hospita of Guangzhou Military Region from the ruptured aneurysm (4mm) patients in 511 cases, of which 261 cases of interventional embolization group, treatment group 250 cases of craniotomy. Inclusion criteria: (1). After CT or lumbar puncture confirmed SAH; (2). DSA 3D double plate rotation angiography confirmed the largest aneurysm the diameter is less than or equal to 4mm; (3). Multiple aneurysms were mainly caused by aneurysm subarachnoid hemorrhage. All patients were in the hospital department of neurosurgery and interventional physicians after preoperative discussion, the patients themselves or their families Signed informed consent.2. main equipment and technology of Germany's SIEMENS Artis Zee biplane DSA System syngo double plate machine, X-WP 3D postprocessing system, conventional DSA image acquisition, through the internal carotid artery, external carotid artery, vertebral artery and internal carotid artery were given contrast agent, 3ml/s, total 18ML, total 15ml, 2.5ml/s of vertebral artery, the the "5sDSA" model, automatic image postprocessing system for transmission to the 3D measurement of aneurysm and understand the aneurysm site.3. were analyzed using the SPSS19.0 statistical software, measurement data to mean + standard deviation (X + S) said the count data expressed as a percentage. Between the two groups using T test for categorical data card square test (or Fisher exact probability analysis), multiple samples of non parametric test and rank test using the Kruskal-Wallis. test standards for a =0.05, the test level is P0.05 as statistically significant. Results: 261 cases of interventional group, 鎬у埆:鐢，

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