电解可脱性弹簧圈栓塞治疗颅内动脉瘤临床研究

摘要

目的 探讨电解可脱性弹簧圈栓塞治疗颅内动脉瘤临床效果. 方法 回顾性分析2010年1月～2015年3月我院收治60例颅内动脉瘤患者,均经脑血管造影确诊为颅内动脉瘤,均为单发.根据手术方法的不同分为两组:治疗组30例,采用电解可脱性弹簧圈(GDS)栓塞治疗,对照组30例,采用开颅动脉瘤夹闭术治疗.比较两组手术结果、并发症发生率及预后(脑出血日常生活能力(ADL)评分). 结果 治疗组30例患者中完全栓塞者22例(73.3％),＞90％栓塞者5例(16.7％),＜90％栓塞者3例(10.0％).其中致密填塞者22例,弹簧圈均稳定;部分填塞者8例,其中稳定者7例,缩小者1例,且无出血.治疗组患者平均住院时间(16.1±3.1)d,明显短于对照组的(23.9±4.3)d(P＜0.05);两组患者手术室费用及总住院费用比较差异无统计学意义(P＞0.05).治疗组无一例死亡,对照组死亡4例(13.3％),两组患者死亡率比较差异有统计学意义(x2=4.29,P＜0.05).治疗组ADL≤Ⅱ级者明显多于对照组,差异有统计学意义(x2 =5.73,P＜0.05).治疗组术后4例(13.3％)发生并发症,其中脑梗塞、脑积水、偏瘫及肺部感染各1例.对照组术后11例(36.7％)发生并发症,其中脑梗塞3例,脑积水2例,偏瘫2例,肺部感染3例,消化道出血1例;治疗组并发症率明显低于对照组,差异有统计学意义(x2 =4.69,P=0.03). 结论 应用电解可脱性弹簧圈栓塞治疗颅内动脉瘤疗效可靠且安全,值得深入研究以推广应用.%Objective To explore the effect of the guglielmi detachable coil (GDC) in the embolization of intracranial aneurysms.Methods A total of 60 intracranial aneurysm cases confirmed by cerebral angiography from January 2010 to March 2015 were analyzed retrospectively.All patients were found single focus of tumor.They were divided into two groups according to surgical procedure:The treatment group (n =30) were performed the intracranial aneurysm embolization with GDC,and the control group (n =30) were carried out craniotomy and aneurysmal clipping.The surgical treatment results,complication incidence and prognosis (ADL score) were compared between two groups.Results In the treatment group,there were complete embolization in 22 cases (73.3％),embolization more than 90％ in 5 cases (16.7％) and less than 90％ in 3cases(10.0％).22 cases were achieved dense embolization with stable coils,and 8 cases were achieved partial embolization with stable coils in 7 and diminution in 1.The hospital stays was shorter in treatment group than in control group ((16.1 ± 3.1) vs.(23.9 ± 4.3),P ＜ 0.05)),but no statistical difference in both cost of operation and hospitalization (P ＞ 0.05).There was statistical difference in mortality between the treatment group and control group(0 vs.13.3％,x2 =4.29,P =0.04).The patients with ADL grade Ⅰ and Ⅱ were 25 cases(83.3％) in the treatment group,and was higher than 14 cases (53.8％) in the control group (x2 =5.73,P =0.02).The post-operative complication was found in 4 cases of treatment group including cerebral infarction,hydrocephalus,hemiplegia and pulmonary infection in 1 case respectively,and in 11 cases of control group including 3 of cerebral infarction,2 of hydrocephalus,2 of hemiplegia,3 of pulmonary infection and 1 of gastrointestinal hemorrhage.There was statistical difference in the incidence of complication between two groups (x2 =4.69,P =0.03).Conclusion The treatment of intracranial aneurysm embolization with GDC is effective and safe,and is worthy of further application.