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Received:August 17, 2022 Published Online:March 20, 2023
Received:August 17, 2022 Published Online:March 20, 2023
中文摘要: 目的 探讨支架半释放辅助栓塞对急性破裂性颅内微小动脉瘤（VSAs）患者手术并发症、改良Rankin量表（mRS）评分及复发率的影响。方法 回顾性选取2009年2月至2019年6月邢台市人民医院收治的296例急性破裂性颅内VSAs患者作为研究对象，以采用单纯弹簧圈栓塞治疗的148例为对照组，采用支架半释放辅助弹簧圈栓塞治疗的148例为观察组，两组均在起病72 h内进行介入术治疗。比较两组Raymond标准的栓塞效果、mRS评分、脑血流动力学指标［局部血容量（rCBV）、局部血流量（rCBF）、达峰时间（TTP）、平均通过时间（MTT）］、手术并发症以及复发率。结果 观察组患者栓塞效果Ⅰ级135例、Ⅱ级10例、Ⅲ级3例，对照组Ⅰ级119例、Ⅱ级20例、Ⅲ级9例，观察组的栓塞效果优于对照组（U=2.690，P＜0.01）；观察组术后1、2，3年的mRS评分低于对照组（P＜0.01）。观察组预后良好率高于对照组（97.30% vs 90.54%，P<0.05）；术后6个月，观察组rCBV、rCBF水平高于对照组，TTP、MTT水平低于对照组（P<0.01）；观察组术后并发症总发生率低于对照组（4.37% vs 11.49%，P＜0.05）；观察组术后1年、2年，尤其3年（6.76% vs 16.22%）的复发率低于对照组（P＜0.05）。结论 支架半释放辅助栓塞对急性破裂性VSAs患者的栓塞效果较好，可显著改善脑血流动力学，降低术后并发症以及复发率，进而改善预后。
Abstract:Objective To investigate the effect of stent semi-release assisted embolization on the surgical complications, modified Rankin scale (mRS) and recurrence rate of patients with acute ruptured very small intracranial aneurysm (VSAs). Methods A total of 296 patients with acute ruptured VSAs admitted to Xingtai People's Hospital were retrospectively enrolled as the research objects from February 2009 to June 2019. According to the different treatment method, they were divided into observation group (n=148, treated with semi-release stent assisted coil embolization) and control group (n=148, treated with simple coil embolization). Both groups received interventional therapy within 72 hours after the onset of the disease. The embolic effect, mRS score, cerebral hemodynamic indexes ［regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), time to peak (TTP), mean transit time (MTT)］, surgical complications and recurrence rate were compared between the two groups. Results In observation group, there were 135 cases with embolization effect at grade Ⅰ, 10 cases at grade Ⅱ and 3 cases at grade Ⅲ. In control group, there were 119 cases with embolization effect at grade Ⅰ, 20 cases at grade Ⅱ and 9 cases at grade Ⅲ. The embolic effect of the observation group was better than that of the control group (U=2.690, P＜0.01); The mRS score of the observation group was lower than that of the control group at 1,2,3 years after operation (P＜0.01). The rate of good prognosis in the observation group was higher than that in the control group (97.30% vs 90.54%, P＜0.05). Six months after operation, the levels of rCBV and rCBF in the observation group were higher than those in the control group, while the levels of TTP and MTT were lower than those in the control group (P＜0.01). The total incidence of postoperative complications in the observation group was lower than that in the control group (4.37% vs 11.49%, P＜0.05). The recurrence rate in the observation group was lower than that in the control group at 1 year, 2 years, especially 3 years after operation (6.76% vs 16.22%, P＜0.05). Conclusion Semi-release stent assisted embolization has a good effect on patients with acute ruptured VSAs. It can significantly improve cerebral hemodynamics, reduce postoperative complications and recurrence rate, and improve prognosis.
keywords: Very small intracranial aneurysm Semi-release stent Embolization Modified Rankin scale Cerebral hemodynamic indexes Postoperative complication Recrudescence
文章编号： 中图分类号：R651.1+2 文献标志码：A
基金项目:河北省卫生健康委科研基金项目课题（20210592）
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