Tykocki Tomasz, Kostyra Kacper, Czyż Marcin, Kostkiewicz Bogusław
Department of Neurosurgery, Institute of Psychiatry and Neurology, Sobieskiego Street No 9, Warsaw, 02-957, Poland,
Acta Neurochir (Wien). 2014 May;156(5):861-8. doi: 10.1007/s00701-014-2006-z. Epub 2014 Feb 6.
The dilemma concerning the appropriate treatment of the intracranial aneurysms (IAs) has not yet been resolved and still remains under fierce debate. This study refers to the recent trends in the use of and outcomes related to coiling compared with clipping for unruptured and ruptured IAs in Poland over a 4-year period.
The analysis refers to treatment of IAs performed in Poland between 2009-2012. Patients' records were cross-matched by ICD-9 codes for ruptured SAH (430) or unruptured cerebral aneurysm (437.3) along with codes for clipping (39.51) and coiling (39.79, 39.72, or 39.52). Multivariable logistic regression was used to compare in-hospital deaths, hospital length of stay (LOS), therapy allocation and aneurysm locations in unruptured vs. ruptured and clipped vs. coiled groups. Differences in the number of procedures between 16 administrative regions were standardized per 100,000 people.
In 2009-2012, 11,051 procedures were identified, including 5,968 ruptured and 5,083 unruptured aneurysms. Overall increase was 2.3 % in clipping and 13.1 % in coiling; a significant trend was found in endovascular procedures (p = 0.044). Ruptured aneurysms were clipped more frequently (OR = 1.66;); in unruptured IAs, endovascular procedure was preferred 3.5 times more than clipping. The annual in-hospital mortality was 7.6 % in clipping and 6.7 % in endovascular treatment. LOS was two times longer after clipping in unruptured aneurysms (OR = 2.013). After the procedures were standardized per 100,000 people, the average for Poland was established as 9.09 in 2009, 10.86 in 2010, 10.55 in 2011, and 11.49 in 2012. This index had the highest values in Mazovia (12.9, 2009; 15.4, 2010; 17.4, 2011; 18.6, 2012.
Data analysis revealed an increase in overall number of IAs treated in Poland between 2009-2012. A significant upward trend of endovascular procedures was found, whereas the number of clipped aneurysms remained relatively steady over the study period.
颅内动脉瘤（IA）恰当治疗方法的困境尚未得到解决，目前仍在激烈争论中。本研究探讨了波兰在4年时间里，未破裂和破裂颅内动脉瘤的血管内栓塞术与夹闭术的使用趋势及相关结果。
分析2009年至2012年在波兰进行的IA治疗情况。通过ICD - 9编码，将破裂蛛网膜下腔出血（430）或未破裂脑动脉瘤（437.3）患者记录与夹闭术（39.51）和血管内栓塞术（39.79、39.72或39.52）编码进行交叉匹配。采用多变量逻辑回归比较未破裂与破裂、夹闭与血管内栓塞组的院内死亡、住院时间（LOS）、治疗分配及动脉瘤位置。16个行政区手术数量差异按每10万人进行标准化。
2009 - 2012年，共识别出11051例手术，其中5968例为破裂动脉瘤，5083例为未破裂动脉瘤。夹闭术总体增长2.3%，血管内栓塞术增长13.1%；血管内手术有显著趋势（p = 0.044）。破裂动脉瘤夹闭更频繁（OR = 1.66）；在未破裂IA中，血管内手术比夹闭术更受青睐，是其3.5倍。夹闭术的年度院内死亡率为7.6%，血管内治疗为6.7%。未破裂动脉瘤夹闭术后住院时间长两倍（OR = 2.013）。按每10万人标准化手术后，波兰2009年平均为9.09，2010年为10.86，2011年为10.55，2012年为11.49。该指数在马佐夫舍省最高（2009年为12.9，2010年为15.4，2011年为17.4，2012年为18.6）。
数据分析显示，2009 - 2012年波兰治疗的IA总数有所增加。血管内手术呈显著上升趋势，而夹闭动脉瘤数量在研究期间保持相对稳定。
