动脉瘤性蛛网膜下腔出血：前循环动脉瘤夹闭术与血管内栓塞术的治疗结果对比
Aneurysmal Subarachnoid Hemorrhage: Outcome of Aneurysm Clipping Versus Coiling in Anterior Circulation Aneurysm.
作者信息
Wadd Ijaz Hussain, Haroon Abdullah, Ansari Safroz, Mukhtar Shahid, Rashid Umair, Vohra Anjum Habib
机构信息
Department of Neurosurgery, Lahore General Hospital, Lahore.
Department of Neurophysician, Lahore General Hospital, Lahore.
出版信息
J Coll Physicians Surg Pak. 2015 Nov;25(11):798-801.
OBJECTIVE
To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm.
STUDY DESIGN
Comparative study.
PLACE AND DURATION OF STUDY
Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013.
METHODOLOGY
Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society (WFNS) grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale (mRS) as favourable (mRS ≤2 ) and unfavourable (mRS > 2).
RESULTS
Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 ± 10 years and in group B was 51.00 ± 10 years. Overall, 56 (40%) males, 28 (60%) males in each group; and 84 (60%) females, 42 (60%) in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 (38.6%) patients had no disability (grades 1 and 2), 25 (35.7%) were slightly disabled (grade 3) and 18 (25.7%) had moderate disability (grade 4); whereas in group B, i.e. clipping group 23 (32.9%) patients had no disability (grades 1 and 2), 23 (32.9%) were slightly disabled (grade 3) and 24 (34.3%) had moderate disability (grade 4). At one year follow-up, in group A, favourable outcome was achieved in 56 (80%) of patients compared to 48 (68.6%) in group B; whilst, 14 (20%) patients in group Aand 22 (33.1%) in group B showed unfavourable outcome. Although mortality rate was higher in clipping (n=3, 4.3%) as compared to coiling (n=1, 1.4%), but was not statistically significant (p = 0.310).
CONCLUSION
Endovascular coiling of anterior circulation aneurysms is safe and as effective and successful as aneurysm clipping and is less invasive also.
目的
比较前循环动脉瘤患者行显微手术夹闭与血管内栓塞术的神经功能预后。
研究设计
对比研究。
研究地点及时间
2010年1月至2013年12月，拉合尔拉合尔总医院神经外科。
方法
纳入年龄在14 - 60岁、前循环脑动脉瘤破裂且世界神经外科联合会（WFNS）分级为1、2和3级的患者。排除年龄超过60岁、身体状况不宜手术的患者、后循环动脉瘤以及WFNS分级为4和5级的患者。采用随机方式对动脉瘤囊进行显微手术夹闭或血管内栓塞。术后，根据WFNS分级和改良Rankin量表（mRS）将患者的预后参数评估并随访一年，分为良好（mRS≤2）和不良（mRS>2）。
结果
在140名入选研究的受试者中，70名被纳入A组，即血管内栓塞组，另外70名被纳入B组，即手术夹闭组。A组患者的中位年龄为52.5±10岁，B组为51.00±10岁。总体而言，共纳入56名（40%）男性，每组28名（60%）；84名（60%）女性，每组42名（60%）。本研究的男女比例为1:1.5。在A组，即血管内栓塞组，27名（38.6%）患者无残疾（1级和2级），25名（35.7%）患者轻度残疾（3级），18名（25.7%）患者中度残疾（4级）；而在B组，即手术夹闭组，23名（32.9%）患者无残疾（1级和2级），23名（32.9%）患者轻度残疾（3级），24名（34.3%）患者中度残疾（4级）。在一年的随访中，A组56名（80%）患者获得良好预后，而B组为48名（68.6%）；同时，A组14名（20%）患者和B组22名（33.1%）患者显示不良预后。尽管手术夹闭组的死亡率（n = 3，4.3%）高于血管内栓塞组（n = 1，1.4%），但差异无统计学意义（p = 0.310）。
结论
前循环动脉瘤的血管内栓塞术安全有效且成功率高，与动脉瘤夹闭术效果相当，且创伤较小。
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