同期栓塞与夹闭治疗老年颅内多发动脉瘤的疗效分析

目的评估同期栓塞和夹闭治疗老年颅内多发动脉瘤的效果。方法回顾性分析2011年5月—2020年5月重庆医科大学附属第一医院神经外科收治的189例老年颅内多发动脉瘤患者的临床资料，包括年龄、性别、吸烟史、高血压病史、临床分级、动脉瘤特点、治疗方式、临床并发症和预后。结果与夹闭组相比，栓塞组同期治疗颅内多发动脉瘤的老年患者比例明显更高（82.2% vs 31.0%，P＜0.05）。进一步分析发现，同期治疗所有动脉瘤的出血和缺血并发症的发生率明显高于仅治疗破裂动脉瘤的（16.8% vs 5.7%;37.0% vs 21.4%，P＜0.05），并且同期治疗所有动脉瘤患者的残疾率明显高于仅治疗破裂动脉瘤的（20.2% vs 5.7%，P＜0.05）。结论同期治疗老年颅内多发动脉瘤有更高的并发症风险，从而增加患者的残疾率。

Objective To assess the efficiency and safety of simultaneous coiling and clipping of multiple intracranial aneurysms in elderly patients. Methods The clinical data of 189 elderly patients with multiple intracranial aneurysms admitted to Department of Neurosurgery, the First Affiliated Hospital, Chongqing Medical University from May 2011 to May 2020 were analyzed retrospectively, including age, gender, smoking history, hypertension history, clinical classification, aneurysm characteristics, treatment methods, clinical complications and prognosis. Results Compared with the clipping group, elderly patients with simultaneous occlusion of all aneurysms were obviously more in the coiling group(82.2% vs. 31.0%，P＜0.05). The incidence of hemorrhagic and ischemic complications ensuing the simultaneous occlusion of all aneurysms was markedly higher than that ensuing the only occlusion of a ruptured aneurysm（16.8% vs. 5.7%, 37.0% vs. 21.4%，P＜0.05）. The morbidity associated with simultaneous occlusion of all aneurysms was significantly higher than that of occlusion the ruptured aneurysm only（20.2% vs. 5.7%，P＜0.05）. Conclusion Simultaneous treatment of all aneurysms is associated with a higher risk of encountering complications in elderly patients which increases morbidity.