Liu Yang, Sun Shengkai, Chen Xuyi, Cheng Shixiang, Qin Zhizhen, Liu Xiu, Chen Xiaochu, Ning Lili, Wang Zhihong
Training Base of Liaoning Medical University, Affiliated Hospital of Logistics University of Chinese Armed Police Forces (CAPF), Neurology and Neurosurgery Hospital of CAPF, Tianjin Key Laboratory of Neuro-trauma Repair, Tianjin 300162, China. Corresponding author: Wang Zhihong, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015 Feb;27(2):133-7. doi: 10.3760/cma.j.issn.2095-4352.2015.02.011.
OBJECTIVE: To analyze and compare the difference and prognosis between vascular embolization and craniotomy occlusion in patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) with Hunt-Hess level III-IV, and acute postoperative hydrocephalus. METHODS: A retrospective study was conducted on 767 patients who had undergone vascular embolization (vascular embolization group, n = 403) or craniotomy occlusion operation (craniotomy occlusion operation group, n = 364), and the patients with postoperative acute hydrocephalus were screened. The clinical data of patients of both groups was analyzed. By judging short-term prognosis in patients with hydrocephalus with Glasgow outcome scale (GOS) score estimated at discharge, the advantages and disadvantages of two surgical procedures were compared. RESULTS: The number of cases with postoperative hydrocephalus in vascular embolization group was 56 (13.90%), while that in craniotomy occlusion group was 33 (9.07%). The difference between the two groups of incidence of hydrocephalus was statistically significant (χ (2) = 4.350, P = 0.037). In 767 patients with aSAH, the incidence of hydrocephalus among the patients after the hematoma removal operation was significantly lower than that of patients without hematoma removal [3.07% (11/358) vs. 19.07% (78/409), χ (2) = 47.635, P = 0.000]. The incidence of hydrocephalus among the patients after ventricular drainage was significantly lower than that of patients without the drainage [2.77% (19/685) vs. 85.37% (70/82), χ (2) = 487.032, P = 0.000]. In 403 cases of vascular embolization group, the incidence of hydrocephalus in the patients after the hematoma removal operation was lower than that of patients without it [8.06% (5/62) vs. 14.96% (51/341), χ (2) = 2.082, P = 0.168]. The incidence of hydrocephalus in the patients after the ventricular drainage was lower than that of patients without drainage [2.59% (9/347) vs. 83.93% (47/56), χ (2) = 266.599, P = 0.000]. In 364 cases of craniotomy occlusion operation group, the incidence of hydrocephalus in the patients after hematoma removal operation was significantly lower than that of patients did not receive [2.03% (6/296) vs. 39.71% (27/68), χ (2) = 95.226, P = 0.000]. The incidence of hydrocephalus among the patients after the ventricular drainage was significantly lower than that of patients without drainage [2.96% (10/338) vs. 88.46% (23/26), χ (2) = 203.852, P = 0.000]. The difference in incidence of hydrocephalus between the patients who had hematoma removal surgery between vascular embolization group and craniotomy occlusion operation group was statistically significant [8.06% (5/62) vs. 2.03% (6/296), χ (2) = 4.411, P = 0.027], while no statistically difference was present in ventricular drainage patients [2.59% (9/347) vs. 2.96% (10/338), χ (2) = 0.085, P = 0.819]. There were 23 patients (41.07%) with good outcome (GOS score 4-5), while 33 (58.93%) with poor outcome (GOS score 1-3) in 56 patients undergone vascular embolization operation. Good result (GOS score 4-5) was shown in 21 (63.64%) and 12 (36.36%) with poor outcome (GOS score 1-3) among 33 patients with hydrocephalus after craniotomy occlusion operation, and the difference was statistically significant (χ (2) = 4.230, P = 0.039). CONCLUSIONS: Hematoma is one of the main factor contributing to the differences in the incidence of postoperative hydrocephalus of Hunt-Hess grade III-IV patients either receiving vascular embolization or craniotomy occlusion operation. Lateral ventricle drainage may not be the factor that contributes to the difference in incidence of hydrocephalus formation between the vascular embolization and craniotomy occlusion operation groups in Hunt-Hess level III-IV patients. The short term prognosis in the craniotomy occlusion operation group is superior to that of endovascular intervention embolization group.
目的：分析和比较血管内栓塞术与开颅夹闭术治疗Hunt-HessⅢ-Ⅳ级动脉瘤性蛛网膜下腔出血（aSAH）患者的差异及预后，以及术后急性脑积水情况。 方法：对767例行血管内栓塞术（血管内栓塞组，n = 403）或开颅夹闭术（开颅夹闭术组，n = 364）的患者进行回顾性研究，并筛选出术后发生急性脑积水的患者。分析两组患者的临床资料。通过采用格拉斯哥预后量表（GOS）评分判断脑积水患者出院时的短期预后，比较两种手术方式的优缺点。 结果：血管内栓塞组术后发生脑积水的病例数为56例（13.90%），而开颅夹闭组为33例（9.07%）。两组脑积水发生率差异有统计学意义（χ² = 4.350，P = 0.037）。在767例aSAH患者中，血肿清除术后患者的脑积水发生率显著低于未行血肿清除术的患者[3.07%（11/358）对19.07%（78/409），χ² = 47.635，P = 0.000]。脑室引流术后患者的脑积水发生率显著低于未行引流的患者[2.77%（19/685）对85.37%（70/82），χ² = 487.032，P = 0.000]。在403例血管内栓塞组病例中，血肿清除术后患者的脑积水发生率低于未行血肿清除术的患者[8.06%（5/62）对14.96%（51/341），χ² = 2.082，P = 0.168]。脑室引流术后患者的脑积水发生率低于未行引流的患者[2.59%（9/347）对83.93%（47/56），χ² = 266.599，P = 0.000]。在364例开颅夹闭术组病例中，血肿清除术后患者的脑积水发生率显著低于未行血肿清除术的患者[2.03%（6/296）对39.71%（27/68），χ² = 95.226，P = 0.000]。脑室引流术后患者的脑积水发生率显著低于未行引流的患者[2.96%（10/338）对88.46%（23/26），χ² = 203.852，P = 0.000]。血管内栓塞组与开颅夹闭术组行血肿清除术患者的脑积水发生率差异有统计学意义[8.06%（5/62）对2.03%（6/296），χ² = 4.411，P = 0.027]，而脑室引流患者无统计学差异[2.59%（9/347）对2.96%（10/338），χ² = 0.085，P = 0.819]。56例行血管内栓塞术的患者中，23例（41.07%）预后良好（GOS评分4 - 5），33例（58.93%）预后不良（GOS评分1 - 3）。33例开颅夹闭术后发生脑积水的患者中，21例（63.64%）预后良好（GOS评分4 - 5），12例（36.36%）预后不良（GOS评分1 - 3），差异有统计学意义（χ² = 4.230，P = 0.039）。 结论：血肿是导致Hunt-HessⅢ-Ⅳ级患者行血管内栓塞术或开颅夹闭术后脑积水发生率差异的主要因素之一。侧脑室引流可能不是导致Hunt-HessⅢ-Ⅳ级患者血管内栓塞术与开颅夹闭术组脑积水形成发生率差异的因素。开颅夹闭术组的短期预后优于血管内介入栓塞组。
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007-6
Zotero 插件