摘要：

目的 探讨血管内栓塞和手术夹闭方案对前循环颅内动脉瘤患者预后、生活质量及术后并发症的影响。方法 选择 2016 年 1 月至 2017 年 10 月确诊的前循环颅内动脉瘤患者共 128 例，随机分为血管内栓塞组（64 例）和手术夹闭组（64 例），评价两组患者住院时间、治疗总费用、手术前后脑组织损伤指标［S-100B 蛋白（S-100B）、基质金属蛋白酶-9（MMP-9）及白细胞介素-6（IL-6）］，术后神经功能预后［Glasgow 预后分级（GOS）和改良 Rankin 量表（mRS）］，生活质量［36 条简明健康状况调查表（SF-36）和日常生活活动能力量表（ADL）］，以及术后并发症发生率。结果 与手术夹闭组相比，血管内栓塞组患者住院时间短（t = 4.712，P = 0.000），S-100B（F = 4.276，P = 0.000）、MMP-9（F = 3.576，P = 0.000）及 IL-6（F =3.897，P = 0.000）水平降低；而且 SF-36（t = 4.673，P = 0.000）和 ADL（t = 3.816，P = 0.000）评分、术后 6 个月时 GOS 分级（χ² = 4.726，P = 0.019）和 mRS 评分（t = 3.816，P = 0.000）均优于手术夹闭组，但治疗总费用高于手术夹闭组（t = 5.046，P = 0.000）。术后 30 d 并发症发生率结果提示，血管内栓塞组感染发生率较低（χ² = 9.195，P = 0.002）。结论 血管内栓塞方案治疗前循环颅内动脉瘤具有住院时间短、远期预后良好等优点，同时可下调 S-100B、MMP-9 和 IL-6 水平，有助于预防感染风险，提高患者生活质量；而手术夹闭方案则在降低经济负担风险等方面具有优势。

关键词: 颅内动脉瘤, 外科手术, 栓塞, 治疗性, 手术后并发症

Abstract:

Objective To investigate the influence of endovascular embolization and surgical clipping on long-term prognosis, quality of life and postoperative complications of patients with anterior circulation intracranial aneurysms. Methods A total of 128 patients with anterior circulation intracranial aneurysms were chosen from January 2016 to October 2017 and randomly divided into 2 groups including group A (N = 64) treated with endovascular embolization and group B (N = 64) treated with surgical clipping. The hospitalization time, total treatment cost, laboratory indexes before and after operation including S-100B protein (S-100B), matrix metalloproteinase-9 (MMP-9) and interleukin-6 (IL-6), postoperative neurological function [Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS)], life quality [Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Activities of Daily Living (ADL)] and postoperative complications incidence of both groups were compared and analyzed. Results Compared with group B, group A had shorter hospitalization time (t = 4.712, P = 0.000), significantly lower levels of S-100B (F = 4.276, P = 0.000), MMP-9 (F = 3.576, P = 0.000) and IL-6 (F = 3.897, P = 0.000), better SF-36 (t = 4.673, P = 0.000) and ADL (t = 3.816, P = 0.000) scores, better GOS (χ² = 4.726, P = 0.019) and mRS (t = 3.816, P = 0.000) scores 6 months after operation. However, the total treatment cost of group A was significantly higher than group B (t = 5.046, P = 0.000). The evaluation of postoperative complications incidence 30 d after operation showed group A had significantly lower infection incidence (χ² = 9.195, P = 0.002) than group B, while there was no significant difference in the incidence of aneurysm rupture, cerebral ischemia, and vasospasm incidence between 2 groups (P > 0.05, for all). Conclusions Endovascular embolization in the treatment of anterior circulation intracranial aneurysms can efficiently shorten hospitalization time, improve long-term prognosis, reduce the levels of S-100B, MMP-9 and IL-6, improve patients' quality of life and be helpful to prevent the infection risk. Surgical clipping has the advantage of reducing the economic burden of patients.

Key words: Intracranial aneurysm, Surgical procedures, operative, Embolization, therapeutic, Postoperative complications