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1、临床放射学杂志2003年第22卷第10期#873#ü介入放射学þ脑动脉瘤破裂开颅夹闭和介入栓塞治疗的临床分析邓东峰,李茂全,刘建民,张庆,陶妙娣,周勇=摘要>目的研究脑动脉瘤破裂在开颅夹闭和介入栓塞治疗上的临床特点,处理方法,危险因素及预后。资料与方法系统地回顾性分析78例(80枚)经开颅夹闭和介入栓塞治疗破裂的脑动脉瘤,男29例,女49例,年龄15~75岁,并将其分为A(介入栓塞42例)、B(开颅夹闭36例)两组,平均年龄A组为61岁,B组为57岁。结果开颅夹闭治疗36例,1例重残,1例死亡;介入栓塞治疗42例,2例重残,无死亡病例;Hun-tHess分级Ó级以下两
2、组治疗结果无统计学差异。结论介入栓塞治疗能处理形态各异和手术不能达到部位的动脉瘤,而大脑中动脉三分叉处宽颈或巨大动脉瘤开颅夹闭则优于介入栓塞治疗。=关键词>颅内动脉瘤夹闭介入栓塞SurgicalClippingorInterventionalEmbolizationfortheTreatmentofCerebralAneurysmRupture:AClinicalAnalysis*DENGDongfeng,LIMaoquan,LIUJianmin,etal.*DepartmentofNeurosurgery,TheAffiliatedEastHospital,Tong
3、jiUniversity,Shanghai200120,P.R.China=Abstract>ObjectiveTostudytheclinicalfeatures,management,riskfactorsandprognosisofrupturedcerebralaneurysmswhichweretreatedwithsurgicalclippingorinterventionalembolization.MaterialsandMethodsSurgicalclippingorinterven-tionalembolizationwasperformedin
4、78patients(29malesand49females,ages15~75)with80rupturedcerebralaneurysms.GroupA(interventionalembolizationgroup)had42caseswithameanageof61.GroupB(surgicalclippinggroup)had36caseswithmeanageof57.Nostatisticdifferenceinclinicaldataexistedbetweenthetwogroups(P>0.05).Functionlevelbeforeanda
5、fterthetherapywasevaluatedwithHun-tHessclassification.ResultsIngroupA,seriousdisablementanddeathoccurredinonecaseeach.IngroupB,seriousdisablementoccurredintwocasesandnodeathoccurred.NostatisticdifferenceinHun-tHessevaluationwasfoundbetweentwogroupsaftertreatment.ConclusionInterventional
6、embolizationshouldbeconsideredasthefirstchoiceforcerebralaneurysmwithitslocationhardlytobereachedbysurgicalprocedure,whilefortheaneurysmshavinghugesizeorbeinglocatedatthebifurcationofcerebralmiddlearterysurgicalclippingtreatmentissuperiortointerventionalemboliza-tion.=Keywords>Aneurysm,
7、intracranialClippingEmbolization对颅内动脉瘤破裂的治疗,随着血管内神经系统介入治疗手段、设备的不断完善和技术日臻成熟,1资料与方法传统的开颅夹闭手术治疗受到挑战;但对动脉瘤的1998年2月~2003年2月间,共收治了经CT介入治疗以及开颅夹闭治疗适应证的掌握,临床常或腰穿证实为蛛网膜下腔出血行脑血管造影(DSA)有分歧。笔者就近5年的78例破裂动脉瘤治疗方检查而确诊的破裂动脉瘤78例(动脉瘤80枚),其法(介入治疗和开颅夹闭治疗)、术中、术后的并发症中实施开颅夹闭36例(36枚)(46.2%)定为B组,血以及治疗体会进
