未破裂颅内动脉瘤接受开颅夹闭和血管内介入治疗的预后危险因素分析

【摘要】目的探讨开颅夹闭和血管内介入治疗未破裂颅内动脉瘤的预后疗效及影响预后的危险因素。方法回顾性分析266例未破裂颅内动脉瘤患者的临床资料，根据不同治疗方式分为开颅夹闭治疗组105例，血管内介入治疗组161例。统计两组的一般资料、预后情况及并发症发生率，分析患者个人史、动脉瘤特征、术后并发症与预后的关系。结果开颅夹闭和血管内介入治疗未破裂颅内动脉瘤均预后良好（均P＞0.05），开颅夹闭术后脑出血、脑血管痉挛、脑积水、颅内感染、肺部感染发生率更高（均P＜0.05）。多因素回归分析显示脑出血、脑血管痉挛、肺部感染是开颅夹闭预后的独立危险因素，后循环动脉瘤、脑梗死及肺部感染是血管内介入预后的独立危险因素（均P＜0.05），年龄与两种治疗方式的预后相关性较小（P＞0.05）。结论未破裂颅内动脉瘤接受开颅夹闭和血管内介入治疗均预后良好,开颅夹闭术后脑出血、脑血管痉挛、脑积水、颅内感染、肺部感染发生率高于血管内介入，但两种治疗方式均预后良好。脑出血、脑血管痉挛、肺部感染与开颅夹闭治疗患者的不良预后相关，后循环动脉瘤、脑梗塞、肺部感染与血管内介入治疗患者的不良预后相关。年龄不应作为开颅夹闭的相对禁忌症。

Abstract: Objective To investigate the prognostic efficacy and risk factors of unruptured intracranial aneurysms(UIAs) treated with craniotomy clipping and intravascular interventional therapy. Methods The clinical data of 266 patients with UIAs were analyzed retrospectively. According to different treatment methods, they were divided into craniotomy clipping treatment group（105 cases） and intravascular interventional treatment group（161 cases）. The clinical data, prognosis and complication rate of the two groups were counted, and the relationship between personal history, aneurysm characteristics, postoperative complications and prognosis was analyzed. Results The prognosis of UIAs treated with craniotomy clipping and intravascular interventional therapy was good(all P>0.05). The incidence of intracerebral hemorrhage, cerebral vasospasm, hydrocephalus, intracranial infection and pulmonary infection after craniotomy clipping were higher(all P<0.05). Multivariate regression analysis showed that intracerebral hemorrhage, cerebral vasospasm and pulmonary infection were independent risk factors for the prognosis of craniotomy clipping. Posterior circulation aneurysm, cerebral infarction and pulmonary infection were independent risk factors for the prognosis of intravascular intervention(all P<0.05). Age had little correlation with the prognosis of the two treatment methods(P>0.05). Conclusions The prognosis of UIAs treated with craniotomy clipping and intravascular intervention is good. The incidence of intracerebral hemorrhage, cerebral vasospasm, hydrocephalus, intracranial infection and pulmonary infection after craniotomy clipping is higher than that of intravascular intervention, but the prognosis of both treatments is good. Intracerebral hemorrhage, cerebral vasospasm and pulmonary infection are related to the poor prognosis of patients treated with craniotomy and clipping. Posterior circulation aneurysms, cerebral infarction and pulmonary infection are related to the poor prognosis of patients treated with intravascular interventional therapy. Age should not be contraindicated for craniotomy.