【摘要】：目的1.研究支架輔助復(fù)雜動脈瘤與顯微外科手術(shù)治療復(fù)雜動脈瘤的現(xiàn)階段療效,分析探討兩類手術(shù)治療效果的優(yōu)劣點。2.通過對比分析,評估兩類治療的適用情況,為臨床復(fù)雜動脈瘤患者的治療提供理論參考。方法回顧我院2012年10月至2016年10月復(fù)雜動脈瘤患者的治療情況,通過術(shù)后評估及回訪,評價支架輔助復(fù)雜動脈瘤與顯微外科手術(shù)治療復(fù)雜動脈瘤的現(xiàn)階段療效。入組標(biāo)準(zhǔn):1.依據(jù)我院內(nèi)可查的頭部CTA、MRA或DSA診斷為顱內(nèi)動脈瘤;2.顱內(nèi)動脈瘤經(jīng)診斷包含瘤體巨大、寬頸、梭形、微小及夾層等的復(fù)雜動脈瘤特性,被定性為復(fù)雜顱內(nèi)動脈瘤;3.該動脈瘤于我院經(jīng)開顱夾閉或介入栓塞手術(shù)治療。排除標(biāo)準(zhǔn):1.術(shù)后患者1年內(nèi)未于我院復(fù)查。2.隨訪1月后患者失訪。通過查閱患者住院病歷資料,回顧性分析入組患者的基本信息:性別、年齡、既往病史等;入院時病人WFNS評分、GCS評分、MRS評分;動脈瘤的位置、數(shù)目、大小及類別;進行的手術(shù)時間、手術(shù)方式、圍手術(shù)期治療措施和住院時間。通過隨訪患者及其影像資料,收集病人發(fā)現(xiàn)動脈瘤和術(shù)后復(fù)查的CTA、DSA資料,根據(jù)患者身體狀況的恢復(fù),依據(jù)MRS評分評價患者的術(shù)后恢復(fù)情況。分析對比兩隊列的MRS評分獲取兩種手術(shù)療效的差異。結(jié)果在已確定的187例患者,74例采用血管內(nèi)支架輔助復(fù)雜動脈瘤治療,113采用顯微外科開顱夾閉手術(shù)治療。最后一次隨訪時間平均為179.6天,平均數(shù)和中位數(shù)時間在血管內(nèi)支架輔助治療隊列為203.9個和176.5天,在外科手術(shù)治療隊列為154天。在年齡、性別、MRS評分、WFNS分級和Fisher分級、中位動脈瘤大小和ICU住院時間方面沒有差別。接受動脈瘤開顱夾閉術(shù)的患者動脈瘤在大腦中動脈占有有較高比例(37.1%比8.8%;P0.001),在其余位置的動脈瘤比例相對較低(P0.001)。94.7%的動脈瘤夾閉術(shù)患者及98.6%的支架輔助動脈瘤栓塞術(shù)患者出院回家。首次和最后的隨訪時改良的Rankin量表評分無明顯差別。大部分患者無明顯的殘疾。血管內(nèi)介入治療隊列的死亡率為2.7%,外科夾閉隊列的死亡率為5.3%;最后隨訪的死亡率血管內(nèi)介入治療為2.7%,外科夾閉術(shù)治療為6.2%(都無明顯統(tǒng)計學(xué)意義)。血管內(nèi)治療到外科手術(shù)治療的轉(zhuǎn)換率為4%。結(jié)論復(fù)雜動脈瘤的治療應(yīng)個體化定制,以血管內(nèi)支架輔助復(fù)雜動脈瘤栓塞術(shù)治療及顯微外科開顱夾閉治療為互補手段。臨床應(yīng)評估患者病情及復(fù)雜動脈瘤的特性后,根據(jù)這兩種治療技術(shù)的優(yōu)勢,給予每位患者選擇最佳的治療方案,以獲取最大的收益結(jié)果。
[Abstract]:Objective 1. To study the therapeutic effect of stent-assisted complex aneurysm and microsurgical treatment of complex aneurysm, and analyze the advantages and disadvantages of the two types of surgical treatment. 2. Through comparative analysis, the application of the two types of treatment is evaluated to provide a theoretical reference for the treatment of complex aneurysms. Methods the treatment of complex aneurysms in our hospital from October 2012 to October 2016 was reviewed. The therapeutic effects of stent-assisted complex aneurysms and microsurgical procedures were evaluated by postoperative evaluation and return visit. Join the group standard: 1. Intracranial aneurysm was diagnosed by CTA,MRA or DSA in our hospital. Intracranial aneurysms are diagnosed as complex aneurysms with large, wide neck, fusiform, tiny and dissecting features, which are characterized as complex intracranial aneurysms. The aneurysm was clipped or interventional embolized in our hospital. Rule 1. The patients were not reexamined in our hospital within 1 year. The patients were not visited after one month follow-up. By consulting the medical records of the patients, the basic information of the patients were analyzed retrospectively: gender, age, past medical history, WFNS score, Mrs score, location, number, size and type of aneurysms. Time of operation, procedure, perioperative treatment and length of stay. The patients were followed up and their imaging data were collected to collect the CTA,DSA data of finding aneurysms and postoperative reexamination. According to the recovery of the patients' physical condition and the MRS score, the patients' postoperative recovery was evaluated. Analysis and comparison of the two cohorts of MRS score to obtain the difference between the two types of surgical outcomes. Results 74 cases of 187 confirmed patients with complex aneurysms were treated by endovascular stent-assisted complex aneurysm treatment with microsurgical clipping. The mean time of the last follow-up was 179.6 days, the mean and median time were 203.9 and 176.5 days in the endovascular stent adjuvant therapy cohort, and 154 days in the surgical treatment cohort. There was no significant difference in age, gender, Mrs score, WFNS grade and Fisher grade, median aneurysm size and length of stay in ICU. The proportion of aneurysms in the middle cerebral artery (37. 1% vs 8. 8%) was higher in the patients undergoing intracranial clipping (37. 1% vs 8. 8% P0.001). The proportion of aneurysms in the rest of the patients was relatively low (P 0. 001). 94.7% of the patients with aneurysm clipping and 98. 6% of the patients with stent-assisted aneurysm embolization were discharged home. There was no significant difference between the first and last follow-up scores of the modified Rankin scale. Most patients have no significant disability. The mortality of intravascular interventional therapy cohort was 2.7%, the mortality of surgical clipping cohort was 5.3%, the last follow-up mortality was 2.7% in intravascular interventional therapy and 6.2% in surgical clipping (no significant difference). The conversion rate from endovascular treatment to surgical treatment was 4%. Conclusion the treatment of complex aneurysms should be individualized. Endovascular stent-assisted embolization of complex aneurysms and microsurgical clipping are complementary methods. After evaluating the patient's condition and the characteristics of complex aneurysm, each patient should be given the best treatment plan according to the advantages of these two treatment techniques, so as to obtain the most beneficial results.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.12

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