Chinese Journal of Contemporary Neurology and Neurosurgery ›› 2019, Vol. 19 ›› Issue (5): 361-366. doi: 10.3969/j.issn.1672-6731.2019.05.011

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Analysis on clinical effect of endovascular embolization and surgical clipping in the treatment of intracranial aneurysms of anterior circulation

CHANG Feng, WANG Xu, CHANG Jin-sheng, SHEN Xue-ming   

  1. Department of Neurosurgery, the People's Hospital of Anyang City, Anyang 455000, He'nan, China
  • Online:2019-05-25 Published:2019-05-24
  • Contact: CHANG Feng (Email: changfeng3000@126.com)

血管内栓塞和手术夹闭治疗前循环颅内动脉瘤疗效分析

常枫, 王序, 常金生, 申学明   

  1. 455000 河南省安阳市人民医院神经外科
  • 通讯作者: 常枫,Email:changfeng3000@126.com

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

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