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[Abstract]:Background cerebrovascular disease is a common disease which threatens the health and life of the human body. Its high incidence, high disability rate and high mortality rate not only seriously damage the health and quality of life of the people, but also bring heavy economic, medical and social burden to families and the state. It is an important public health problem. The incidence of ruptured aneurysm is inferior to cerebral thrombosis and hypertensive intracerebral hemorrhage. It occurs mostly in the branches, bifurcations, turning points and adjacent areas of the large cerebral artery. It is common in the Willis artery ring area of the skull base. Once the aneurysm is broken, the risk of bleeding is very high and it is easy to endanger the life, so the aneurysm should be timely. Diagnosis and treatment to improve the prognosis. There are two main types of surgical treatment for intracranial aneurysms: craniotomy clipping and intravascular interventional embolization. Craniotomy aneurysm clipping is the main surgical treatment for aneurysms in the last 50 years. With the use of the surgical microscope, the development of microsurgical instruments and techniques in the microscopical Department of Neurosurgery The incidence of complications is greatly reduced. Interventional embolization begins in 1970s. With the continuous improvement of interventional techniques and embolic materials, it has become an important method for the treatment of aneurysm. However, the two surgical methods have different shortcomings. Craniotomy has a large trauma, a definite injury to the brain tissue, and a higher incidence of infection and other complications. Interventional embolization is difficult to deal with. Interventional embolization is less traumatic and has no stimulation to the brain tissue, but it has great stimulation to the blood vessels. It may lead to vascular spasm even occlusion and the coil displacement and other complications, and the cost is high. At present, most of the major hospitals at home and abroad are two kinds of surgical methods and exist, with the improvement of people's living standard and medical insurance. While the patients are constantly improving, the patients are also paying more attention to the effect of the treatment while considering the economic problems. However, there are still great disputes in the treatment of intracranial aneurysms with craniotomy and interventional embolization. The purpose of this study is to explore the two main surgical methods for the treatment of craniotomy and interventional embolization for patients with intracranial ruptured aneurysms. Compared with the recent clinical effects, major postoperative complications, hospitalization time, and hospitalization costs, we provided a theoretical basis for selecting appropriate surgical methods for patients with intracranial aneurysm rupture from clinical efficacy and economic burden. Materials and methods were derived from July 2011 to July 2015 at the Yantai Affiliated Hospital of Binzhou Medical University. A total of 102 patients with intracranial ruptured aneurysms treated by surgical treatment were selected according to the inclusion and exclusion criteria, including 52 patients with craniotomy and 50 patients treated with intravascular interventional embolization. The age, sex, history of important diseases (such as diabetes, hypertension, coronary heart disease, etc.) in the two groups were compared. Risk form, preoperative Hunt-Hess grading, preoperative GCS score, and two groups of 2 weeks GCS score, hospitalization time, total hospitalization expenses, postoperative complications (rebleeding, hydrocephalus, cerebral vasospasm, cerebral infarction, intracranial infection, pulmonary infection, etc.), and MRS scores in January after operation were analyzed by single factor analysis, and multiple linear regression and 1ogis were applied. Tic regression analysis was used to control the possible confounding factors and to compare the indexes of the two groups. The comparison of the clinical data of the patients before the operation showed that the age of the patients in the craniotomy group was less than that of the interventional embolization group (P=).005), the proportion of the urban residents insured was higher than that of the embolization group (p=0.037), and the proportion of the history of hypertension was higher than that of the patients. In the interventional embolization group (0.058), the preoperative GCS score was lower than that of the interventional embolization group (0.003), and the preoperative Hunt-Hess classification was higher than that of the interventional embolization group (0.014). In this study, the hospitalization time of the craniotomy group was 23.81 + 4.78 days, the total cost of hospitalization of the individual patients was 12 thousand and 900 yuan, the postoperative GCS score was 13.33 + 3.07, and the postoperative complications were 13 cases (25%). In January, the MRS score was 0 (42.3%), 1 in 11 (21.2%), and 19 (36.5%) in 2 and above. The hospitalization time of the interventional embolization group was 18.58 + 3.69 days. The total cost of hospitalization in a single patient was 12.03 + 37 thousand and 900 yuan. After the operation, the GCS score was 42.3%. Cases (34%), 2 points and 6 cases (12%). The single factor analysis of postoperative clinical indexes in two groups showed that the time of hospitalization in the craniotomy group was longer than that of interventional embolization group (P0.001), the total cost of individual patients was lower than that of interventional embolization group (P0.001), and the postoperative GCS score was lower than that of interventional embolization group (P=0.034), and the proportion of postoperative complications was higher than that in the intervention group (P= 0.092), the postoperative MRS score was higher than that of interventional embolization group (P=0.014). After multiple linear regression analysis to control the related confounding factors, the clinical indexes of the two groups after operation showed that the time of hospitalization in the craniotomy group was 5.6 days longer than that of the interventional embolization group (P0.001), and the total cost of individual patients was 49 thousand yuan lower than that of the interventional embolization group (P0.001). In the two groups, the postoperative GCS score (P=0.838), postoperative complication rate (P=0.540), postoperative MRS score of 1 (P=0.955) or greater than 2 (P=0.152) had no statistical difference. Conclusion there was no significant difference in the short-term prognosis of intracranial ruptured aneurysm patients treated with craniotomy and interventional embolization; patients treated with craniotomy were treated with craniotomy Hospitalization time is longer, and the cost of hospitalization is higher in patients undergoing interventional embolization. Patients can choose according to their own conditions.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.12

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