血管内栓塞和手术夹闭治疗前循环颅内动脉瘤疗效分析
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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(χ~2=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(χ~2=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。
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-100 B), 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( χ~2= 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(χ~2= 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.
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-100 B), 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( χ~2= 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(χ~2= 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.
引文
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[6]Li WS,Zhang XF,Xu WT,Guo XW,Wang G,Jiang HT,Zhang HT,Ren JJ,Liang XK,Zhang QZ.Comparative study of surgical clipping and endovascular embolization in the treatment of ruptured posterior communicating artery aneurysms[J].Zhongguo Wei Qin Xi Shen Jing Wai Ke Za Zhi,2018,23:111-114[.李文帅,张信芳,徐文涛,郭西文,王刚,姜海涛,张宏图,任建军,梁宪坤,张全忠.血管内栓塞与开颅夹闭治疗破裂后交通动脉瘤的对比研究[J].中国微侵袭神经外科杂志,2018,23:111-114.]
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[9]Petr O,Brinjikji W,Burrows AM,Cloft H,Kallmes DF,Lanzino G.Safety and efficacy of endovascular treatment for intracranial infectious aneurysms:a systematic review and metaanalysis[J].J Neuroradiol,2016,43:309-316.
[10]Pumar JM,Banguero A,Cuellar H,Guimaraens L,Masso J,Miralbes S,Blanco-Ulla M,Vazquez-Herrero F,Souto M,Gelabert-Gonzalez M.Treatment of intracranial aneurysms with the SILK embolization device in a multicenter study:a retrospective data analysis[J].Neurosurgery,2017,81:595-601.
[11]Liu HW,Tao SZ,Chen H,Wang DQ.Analysis of clinical effect of different approaches for clipping anterior circulation aneurysms[J].Chongqing Yi Xue,2017,46:3928-3930.[刘海巍,陶胜忠,陈辉,王德群.不同入路夹闭前循环动脉瘤的临床疗效分析[J].重庆医学,2017,46:3928-3930.]
[12]Wang GQ,Xu WZ.Efficacy comparison of microscopic neurosurgical clipping and endovascular embolization in intracranial aneurysm[J].Zhongguo Shi Yong Shen Jing Ji Bing Za Zhi,2018,21:1338-1143[.王高强,徐文中.显微开颅夹闭术与血管内栓塞对颅内前循环动脉瘤患者的疗效比较[J].中国实用神经疾病杂志,2018,21:1338-1143.]
[13]Park YK,Yi HJ,Choi KS,Lee YJ,Chun HJ.Intraprocedural rupture during endovascular treatment of intracranial aneurysm:clinical results and literature review[J].World Neurosurg,2018,91:E605-615.
[14]Hernández-Durán S,Mielke D,Rohde V,Malinova V.The application of the unruptured intracranial aneurysm treatment score:a retrospective,single-center study[J].Neurosurg Rev,2018,32:1021-1028.
[15]Brinjikji W,Ding YH,Kallmes DF,Kadirvel R.From bench to bedside:utility of the rabbit elastase aneurysm model in preclinical studies of intracranial aneurysm treatment[J].JNeurointer Surg,2016,8:521-525.
[16]Jung SC,Kim CH,Ahn JH,Cho YD,Kang HS,Cho WS,Kim JE,Ahn C,Han MH.Endovascular treatment of intracranial aneurysms in patients with autosomal dominant polycystic kidney disease[J].Neurosurgery,2016,78:429-435.
[17]Yang JQ,Wang FW,Xue Y,Li L,Wang ZB.Analysis of therapeutic effects of endovascular embolization and microsurgical clipping on intracranial aneurysms[J].Zhongguo Lin Chuang Shen Jing Wai Ke Za Zhi,2018,23:727-728[.杨金庆,王凤伟,薛勇,李龙,王兆斌.血管内栓塞术和开颅夹闭手术治疗颅内动脉瘤的对比分析[J].中国临床神经外科杂志,2018,23:727-728.]
[18]Han MS,Jung SH,Kim TS,Joo SP.Reconstructive endovascular treatment of an intracranial infectious aneurysm in bacterial meningitis:a case report and review of literature[J]. World Neurosurg,2016,90:700-706.
[19]Zhao J,Lin H,Summers R,Yang M,Cousins BG,Tsui J.Current treatment strategies for intracranial aneurysms[J].Angiology,2018,69:17-30.
[20]Jing L,Zhong J,Liu J,Yang X,Paliwal N,Meng H,Wang S,Zhang Y.Hemodynamic effect of flow diverter and coils in the treatment of large and giant intracranial aneurysms[J].World Neurosurg,2016,89:199-207.
[2]Morais R,Mine B,Bruyère PJ,Naeije G,Lubicz B.Endovascular treatment of intracranial aneurysms with the p64flow diverter stent:mid-term results in 35 patients with 41intracranial aneurysms[J].Neuroradiology,2017,59:263-269.
[3]Briganti F,Leone G,Ugga L,Marseglia M,Solari D,Caranci F,Mariniello G,Maiuri F,Cappabianca P.Safety and efficacy of flow re-direction endoluminal device(FRED)in the treatment of cerebral aneurysms:a single center experience[J].Acta Neurochir(Wien),2016,158:1745-1755.
[4]Zhou LF.Modern neurosurgery[M].Shanghai:Fudan University Press,2015:102-103.[周良辅.现代神经外科学[M].上海:复旦大学出版社,2015:102-103.]
[5]Esenkaya A,Duzgun F,Cinar C,Bozkaya H,Eraslan C,Ozgiray E,Oran I.Endovascular treatment of intracranial infectious aneurysms[J].Neuroradiology,2016,58:277-284.
[6]Li WS,Zhang XF,Xu WT,Guo XW,Wang G,Jiang HT,Zhang HT,Ren JJ,Liang XK,Zhang QZ.Comparative study of surgical clipping and endovascular embolization in the treatment of ruptured posterior communicating artery aneurysms[J].Zhongguo Wei Qin Xi Shen Jing Wai Ke Za Zhi,2018,23:111-114[.李文帅,张信芳,徐文涛,郭西文,王刚,姜海涛,张宏图,任建军,梁宪坤,张全忠.血管内栓塞与开颅夹闭治疗破裂后交通动脉瘤的对比研究[J].中国微侵袭神经外科杂志,2018,23:111-114.]
[7]Sonig A,Shallwani H,Natarajan SK,Shakir HJ,Hopkins LN,Snyder KV,Siddiqui AH,Levy EI.Better outcomes and reduced hospitalization cost are associated with ultra-early treatment of ruptured intracranial aneurysms:a US nationwide data sample study[J].Neurosurgery,2017,82:497-505.
[8]Ambekar S,Khandelwal P,Bhattacharya P,Watanabe M,Yavagal DR.Treatment of unruptured intracranial aneurysms:a review[J].Expert Rev Neurother,2016,16:1205-1216.
[9]Petr O,Brinjikji W,Burrows AM,Cloft H,Kallmes DF,Lanzino G.Safety and efficacy of endovascular treatment for intracranial infectious aneurysms:a systematic review and metaanalysis[J].J Neuroradiol,2016,43:309-316.
[10]Pumar JM,Banguero A,Cuellar H,Guimaraens L,Masso J,Miralbes S,Blanco-Ulla M,Vazquez-Herrero F,Souto M,Gelabert-Gonzalez M.Treatment of intracranial aneurysms with the SILK embolization device in a multicenter study:a retrospective data analysis[J].Neurosurgery,2017,81:595-601.
[11]Liu HW,Tao SZ,Chen H,Wang DQ.Analysis of clinical effect of different approaches for clipping anterior circulation aneurysms[J].Chongqing Yi Xue,2017,46:3928-3930.[刘海巍,陶胜忠,陈辉,王德群.不同入路夹闭前循环动脉瘤的临床疗效分析[J].重庆医学,2017,46:3928-3930.]
[12]Wang GQ,Xu WZ.Efficacy comparison of microscopic neurosurgical clipping and endovascular embolization in intracranial aneurysm[J].Zhongguo Shi Yong Shen Jing Ji Bing Za Zhi,2018,21:1338-1143[.王高强,徐文中.显微开颅夹闭术与血管内栓塞对颅内前循环动脉瘤患者的疗效比较[J].中国实用神经疾病杂志,2018,21:1338-1143.]
[13]Park YK,Yi HJ,Choi KS,Lee YJ,Chun HJ.Intraprocedural rupture during endovascular treatment of intracranial aneurysm:clinical results and literature review[J].World Neurosurg,2018,91:E605-615.
[14]Hernández-Durán S,Mielke D,Rohde V,Malinova V.The application of the unruptured intracranial aneurysm treatment score:a retrospective,single-center study[J].Neurosurg Rev,2018,32:1021-1028.
[15]Brinjikji W,Ding YH,Kallmes DF,Kadirvel R.From bench to bedside:utility of the rabbit elastase aneurysm model in preclinical studies of intracranial aneurysm treatment[J].JNeurointer Surg,2016,8:521-525.
[16]Jung SC,Kim CH,Ahn JH,Cho YD,Kang HS,Cho WS,Kim JE,Ahn C,Han MH.Endovascular treatment of intracranial aneurysms in patients with autosomal dominant polycystic kidney disease[J].Neurosurgery,2016,78:429-435.
[17]Yang JQ,Wang FW,Xue Y,Li L,Wang ZB.Analysis of therapeutic effects of endovascular embolization and microsurgical clipping on intracranial aneurysms[J].Zhongguo Lin Chuang Shen Jing Wai Ke Za Zhi,2018,23:727-728[.杨金庆,王凤伟,薛勇,李龙,王兆斌.血管内栓塞术和开颅夹闭手术治疗颅内动脉瘤的对比分析[J].中国临床神经外科杂志,2018,23:727-728.]
[18]Han MS,Jung SH,Kim TS,Joo SP.Reconstructive endovascular treatment of an intracranial infectious aneurysm in bacterial meningitis:a case report and review of literature[J]. World Neurosurg,2016,90:700-706.
[19]Zhao J,Lin H,Summers R,Yang M,Cousins BG,Tsui J.Current treatment strategies for intracranial aneurysms[J].Angiology,2018,69:17-30.
[20]Jing L,Zhong J,Liu J,Yang X,Paliwal N,Meng H,Wang S,Zhang Y.Hemodynamic effect of flow diverter and coils in the treatment of large and giant intracranial aneurysms[J].World Neurosurg,2016,89:199-207.