分流技术和支架辅助弹簧圈栓塞术治疗大型和巨大型颅内动脉瘤有效性和安全性的对比研究

摘要

目的 比较分流技术和支架辅助弹簧圈栓塞术治疗大型和巨大型颅内动脉瘤的有效性和安全性.方法 选取2011年8月—2016年12月榆林市第一医院收治的大型和巨大型颅内动脉瘤患者124例,其中采用分流技术治疗者68例(A组)、采用支架辅助弹簧圈栓塞术治疗者56例(B组).回顾性分析两组患者的临床资料及随访资料,并采用倾向评分法校正临床资料间的不均衡性.结果 两组患者男性比例、年龄、高血压发生率、动脉瘤位置、前期接受治疗者所占比例、动脉瘤颈部直径比较,差异无统计学意义(P＞0.05);两组患者动脉瘤最大直径及动脉瘤形态学分型比较,差异有统计学意义(P＜0.05).按照1:1最邻近匹配法匹配后A组和B组患者均为48例;两组患者男性比例、年龄、高血压发生率、前期接受治疗者所占比例、动脉瘤位置、动脉瘤最大直径、动脉瘤颈部直径及动脉瘤形态学分型比较,差异均无统计学意义(P＞0.05).两组患者随访6个月均未出现迟发性并发症,两组患者术后动脉瘤闭塞分级、手术期间并发症发生率及改良Rankin量表(MRS)评分比较,差异无统计学意义(P＞0.05).96例患者动脉瘤可行血管造影检查者74例,其中A组36例、B组38例;随访6个月,A组患者动脉瘤闭塞分级和动脉瘤转归优于B组(P＜0.05),而两组患者载瘤动脉狭窄程度比较,差异无统计学意义(P＞0.05).结论 与支架辅助弹簧圈栓塞术相比,分流技术能更有效地改善大型和巨大型动脉瘤患者远期动脉瘤闭塞情况及动脉瘤转归.%Objective To compare the effectiveness and safety in treating large or giant intracranial aneurysm between flow dividing technology and stent-assisted spring coiling embolization.Methods A total of 124 patients with large or giant intracranial aneurysm were selected in the First Hospital of Yulin from August 2011 to December 2016,thereinto 68 cases treated by flow dividing technology were served as A group,other 56 cases treated by stent-assisted spring coiling embolization were served as B group.Clinical data and follow-up results were compared between the two group,and propensity score method was used to adjust the malconformation of clinical data.Results No statistically significant differences of male ratio,age,incidence of hypertension,aneurysm position,proportion of patients received prophase treatment or aneurysm neck diameter was found between the two groups (P ＞ 0.05),while there were statistically significant differences of maximum diameter of aneurysm and morphologic classification of aneurysm between the two groups (P ＜ 0.05).After matching according to the nearest neighbor matching method,each group enrolled 48 cases;no statistically significant differences of male ratio,age,incidence of hypertension,aneurysm position,proportion of patients received prophase treatment,aneurysm neck diameter,maximum diameter of aneurysm or morphologic classification of aneurysm was found between the two groups (P ＞ 0.05).No one of the two groups occurred delayed complications during the 6-month follow-up,no statistically significant differences of postoperative aneurysm occlusion grading,intraoperative complications or MRS score was found between the two groups (P ＞ 0.05).Of the 96 cases,74 cases received angiography examination,including 36 cases of A group and 38 cases of B group;occlusion grading and outcome of aneurysm of A group were statistically significantly better than those of B group (P ＜0.05),while no statistically significant differences of stenosis degree of parent arteries was found between the two groups (P ＞ 0.05).Conclusion Compared with stent-assisted spring coiling embolization,flow dividing technology can more effectivly improve the long-term aneurysm occlusion situation and outcome in patients with large or giant intracranial aneurysm.