【摘要】：目的:分析未破裂的窄頸小動(dòng)脈瘤早期行介入栓塞治療的治療效果,為早期臨床治療未破裂小動(dòng)瘤提供參考方法:回顧性分析了我院神經(jīng)外一科2014年1月-2017年1月間73例顱內(nèi)未破裂小動(dòng)脈瘤病患病歷資料,根據(jù)腦血管造影(DSA)檢查測(cè)得未破裂的顱內(nèi)動(dòng)脈瘤直徑的大小、動(dòng)脈瘤頸長(zhǎng)、動(dòng)脈瘤體長(zhǎng),并依此選取小動(dòng)脈瘤(直徑0.5cm)中的窄頸動(dòng)脈瘤(頸體比≤1/2)并分為介入治療組和保守觀(guān)察組。介入治療組患者于全麻下行介入栓塞治療,術(shù)后均予以脫水降顱壓、預(yù)防腦血管痙攣、調(diào)節(jié)電解質(zhì)平衡等對(duì)癥治療。依據(jù)動(dòng)脈瘤完全栓塞的程度分為完全栓塞(100%)、次全栓塞(90%~99%)和失敗栓塞(90%)三個(gè)等級(jí)以便后期隨診觀(guān)察中參考對(duì)比。參考患者的神經(jīng)功能及康復(fù)情況依據(jù)GOS預(yù)后評(píng)分(格拉斯哥預(yù)后評(píng)分)進(jìn)行評(píng)分,死亡為1分,植物生存為2分,重度殘疾為3分,良好為4分以上。兩組患者采用電話(huà)及門(mén)診隨訪(fǎng)的方式間隔6個(gè)月進(jìn)行后續(xù)跟蹤隨訪(fǎng),隨訪(fǎng)率100%。統(tǒng)計(jì)并發(fā)癥發(fā)生率,匯總相關(guān)數(shù)據(jù),采取SPSS 17.0軟件進(jìn)行統(tǒng)計(jì)分析,計(jì)數(shù)資料以比例和百分?jǐn)?shù)(%)表示,組間比較采用?2比較;計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(?s)表示,組間比較采用t檢驗(yàn),檢驗(yàn)水準(zhǔn)為0.05,P0.05表示有差異,有統(tǒng)計(jì)學(xué)意義。結(jié)果:(1)介入治療組24例中22例患者(92%)達(dá)到完全栓塞,2例患者(8%)達(dá)到次級(jí)栓塞,但術(shù)后隨訪(fǎng)中未見(jiàn)栓塞的動(dòng)脈瘤復(fù)發(fā)變大,變化率為0%。保守觀(guān)察組中的49例患者中在隨訪(fǎng)觀(guān)察過(guò)程中有2例患者行影像學(xué)檢查發(fā)現(xiàn)動(dòng)脈瘤變大,變化率為4%,但差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);(2)介入栓塞組中的24例患者中2例患者術(shù)后復(fù)查CT出現(xiàn)高信號(hào),提示腦出血,經(jīng)在院對(duì)癥予以治療后術(shù)后30天GOS預(yù)后評(píng)分均達(dá)4分以上;保守觀(guān)察組中的49例患者在隨診觀(guān)察過(guò)程中中8例患者動(dòng)脈瘤破裂致蛛網(wǎng)膜下腔出血行入院治療,其中的2例患者雖經(jīng)入院治療但因病情較重致死亡。統(tǒng)計(jì)學(xué)計(jì)算P0.05,差異有統(tǒng)計(jì)學(xué)意見(jiàn);(3)在統(tǒng)計(jì)動(dòng)脈瘤變化情況時(shí),保守觀(guān)察組中動(dòng)脈瘤破裂的患者未計(jì)算在內(nèi),綜合兩表對(duì)比情況,介入治療組的8%要明顯低于保守觀(guān)察組的20%。結(jié)論:通過(guò)比較介入治療和保守觀(guān)察未破裂的小動(dòng)脈瘤的治療效果分析,對(duì)于未破裂的小動(dòng)脈瘤,早期行介入栓塞治療后能一定程度上降低動(dòng)脈瘤破裂風(fēng)險(xiǎn),降低了患者因動(dòng)脈瘤破裂后出血而導(dǎo)致嚴(yán)重的傷殘、甚至死亡的風(fēng)險(xiǎn);另外未破裂的小動(dòng)脈瘤患者早期行介入栓塞治療后在后期的隨診觀(guān)察過(guò)程中可看出術(shù)后動(dòng)脈瘤復(fù)發(fā)變大情況要明顯低于保守觀(guān)察組中的患者,因而也相應(yīng)降低了動(dòng)脈瘤在隨診觀(guān)察過(guò)程中因動(dòng)脈瘤變化增高的動(dòng)脈瘤破裂風(fēng)險(xiǎn)率。隨著神經(jīng)影像學(xué)的高速發(fā)展,越來(lái)越多的未破裂小動(dòng)脈瘤得以被明確診斷,而且生物學(xué)、新興材料學(xué)的發(fā)展為小動(dòng)脈的治療提供了條件,支架輔助、球囊輔助及血流導(dǎo)向裝置等新治療手術(shù)大大降低了手術(shù)風(fēng)險(xiǎn)及并發(fā)癥概率,使得更多的患者得以受益。
[Abstract]:Objective: To analyze the therapeutic effect of early interventional embolization for small unruptured aneurysms of narrow neck, and to provide reference for early clinical treatment of small unruptured aneurysms. Narrow carotid aneurysms (neck-to-body ratio < 1/2) of small aneurysms (diameter 0.5 cm) were selected and divided into intervention group and conservative observation group. Patients in intervention group were treated with interventional embolization under general anesthesia, and dehydration was performed after operation to reduce intracranial pressure and prevent cerebrovascular diseases. Symptomatic treatments such as spasm, electrolyte balance adjustment, etc. were classified as complete embolization (100%), subtotal embolization (90%-99%) and failed embolization (90%) according to the degree of complete embolization for later follow-up observation. The neurological function and rehabilitation of the patients were evaluated according to GOS prognostic score (Glasgow prognostic score). Two groups of patients were followed up by telephone and outpatient follow-up for 6 months with a follow-up rate of 100%. The incidence of complications was statistically analyzed, and relevant data were collected. SPSS 17.0 software was used for statistical analysis. The data were counted in proportion and percentage (%) table. Results: (1) In the interventional treatment group, 22 patients (92%) achieved complete embolism, 2 patients (8%) achieved secondary embolism, but no embolism was found in the follow-up. The recurrence rate of aneurysms was 0%. In the conservative observation group, 2 of the 49 patients with aneurysms were found to be enlarged by imaging examination, the change rate was 4%, but the difference was not statistically significant (P 0.05); (2) In the interventional embolization group, 2 of the 24 patients had high signal on CT after operation, suggesting cerebral hemorrhage, and were hospitalized. The GOS prognostic score of 49 patients in the conservative observation group was above 4 on the 30th day after treatment; 8 patients with subarachnoid hemorrhage caused by rupture of aneurysm in conservative observation group were admitted to hospital for treatment, 2 of them were admitted to hospital for treatment but died due to serious illness. The difference was statistically significant (P 0.05). (3) In the conservative observation group, 8% of the patients with ruptured aneurysms were significantly lower than 20% of the conservative observation group when the changes of aneurysms were counted. Conclusion: By comparing the effects of interventional therapy and conservative observation on the treatment of unruptured small aneurysms, the unruptured small aneurysms were analyzed. Early interventional embolization can reduce the risk of rupture of aneurysm to a certain extent, and reduce the risk of serious disability or even death due to bleeding after rupture of aneurysm. With the rapid development of neuroimaging, more and more unruptured small aneurysms have been clearly diagnosed, and biology, emerging materials science has developed into Stent-assisted, balloon-assisted, and blood-flow-guided procedures greatly reduce the risk and probability of complications and benefit more patients.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R743

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