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颅内动脉瘤显微手术夹闭与血管内栓塞治疗对延迟性脑缺血的影响
刘平,黄海林,钟琪,游潮,成刚
0
(绵阳市中心医院神经外科;四川大学华西医院神经外科)
摘要:
【摘要】 目的 探讨颅内动脉瘤显微手术夹闭与血管内栓塞治疗对延迟性脑缺血(DCI)的影响。方法 回顾性分析2015年1月~2017年1月间收治的108例动脉瘤性蛛网膜下腔出血(ASAH)患者临床资料,根据手术方式分为介入组(n=52)和夹闭组(n=56),介入组应用血管内栓塞术,夹闭组应用显微瘤颈夹闭术。比较术后1周、2周DCI发生率,评估两组术前及术后3天时免疫功能[免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)]、血清炎性因子[肿瘤坏死因子α(TNFα)、超敏C反应蛋白(hsCRP)、白介素6(IL6)],记录两组患者并发症发生率,随访6个月评估两组预后状况[改良Rankin量表(mRS)]。结果 介入组术后1周、2周DCI发生率、随访6月时平均mRS得分均低于夹闭组(P<0.05);术后3天时,两组IgG、IgM、IgA均低于术前(P<0.05),介入组降幅小于夹闭组(P<0.05);术后3天时,两组TNFα、hsCRP、IL6指标水平均高于术前(P<0.05),介入组增幅小于夹闭组(P<0.05);两组并发症发生率对比差异无统计学意义(P>0.05)。结论 对ASAH患者行血管内栓塞术较显微瘤颈夹闭术术后DCI发生风险低,且有利于改善ASAH患者术后免疫功能、血清炎症因子水平及预后状况。
关键词:  蛛网膜下腔出血  脑血管痉挛  显微瘤颈夹闭术  血管内栓塞术  DCI
DOI:
基金项目:国家科技支撑计划课题
Effects of microsurgical clipping of aneurysm neck and endovascular embolization on delayed cerebral ischemia
LIU Ping,HUANG Hailin,ZHONG Qi,YOU Chao,CHENG Gang
(Department of Neurosurgery, Mianyang Central Hospital;Department of Neurosurgery, West China Hospital, Sichuan University)
Abstract:
【Abstract】 Objective To explore the effects of microsurgical clipping of aneurysm neck and endovascular embolization on delayed cerebral ischemia (DCI). Methods The clinical data of 108 patients with aneurysmal subarachnoid hemorrhage (ASAH) admitted from January 2015 to January 2017 were analyzed, retrospectively. The patients were divided into intervention group (n=52) and clipping group (n=56) according to the surgical methods. Intervention group was given endovascular embolization, and clipping group was treated with microsurgical clipping of aneurysm neck. The DCI incidence rate at 1w and 2w after operation was compared, and the levels of immune function[immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA)]and serum inflammatory factors[tumor necrosis factorα(TNFα), highsensitivity C reactive protein (hsCRP), interleukin6 (IL-6)]were recorded in the two groups before operation and at 3d after operation, and the incidence rate of complications was recorded in the two groups, and the prognosis[modified Rankin scale (mRS)]was evaluated at 6 months of followup. Results The DCI incidence rate at 1w and 2w after operation and the average mRS score at 6 months of followup in intervention group were lower than those in clipping group (P<0.05). At 3d after operation, the levels of IgG, IgM and IgA in the two groups were lower than those before operation (P<0.05), and the decrease in intervention group was smaller than that in clipping group (P<0.05). At 3d after operation, the levels of TNFα, hsCRP and IL6 in the two groups were higher than those before operation (P<0.05), and the increase in intervention group was smaller than that in clipping group (P<0.05). There was no significant difference in the incidence rate of complications between the two groups (P>0.05). Conclusion Endovascular embolization has lower risk of postoperative DCI than microsurgical clipping of aneurysm neck, and the former one is beneficial to improve the postoperative immune function, serum inflammatory factors and prognosis in ASAH patients.
Key words:  Subarachnoid hemorrhage  Cerebral vasospasm  Microsurgical clipping of aneurysm neck  Endovascular embolization  DCI

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