不同治疗方式对动脉瘤性蛛网膜下腔出血后.docVIP

不同治疗方式对动脉瘤性蛛网膜下腔出血后 慢性脑积水发病率的影响 孙立鹏，战华，王宁，孟祥喜，田荣振 【摘要】 目的 比较开颅夹闭及血管内栓塞治疗对动脉瘤性蛛网膜下腔出血（aSAH）后慢性脑积水发病率的影响；探讨动脉瘤的部位与慢性脑积水发生的相关性。方法 回顾性分析2008年1月-2011年12月于哈尔滨医科大学附属第一临床医学院神经外科住院治疗的aSAH患者1018例。将符合入选标准的857例病例按治疗方式的不同分为开颅夹闭治疗组（A组,560例）及血管内栓塞治疗组（B组,297例），对术后慢性脑积水的发病情况进行统计分析。 结果 所有857例患者中，术后慢性脑积水总的发病率为12.5%，A、B组分别为10.1%和16.8%，两者有显著统计学差异；前交通动脉(ACoA)瘤、PCoA)瘤、MCA)动脉瘤组慢性脑积水的发生率分别为13.8%，13.6%和6.9%，差异没有统计学意义；动脉瘤ACoA组和PCoA组两种治疗方式后发生慢性脑积水的风险均相当，而MCA组两种治疗方式存在显著差异。 结论 开颅夹闭治疗aSAH后并发慢性脑积水的风险低于血管内栓塞治疗；动脉瘤的部位与aSAH后慢性脑积水的发生之间没有相关性，但是不同部位动脉瘤两种治疗方式后发生慢性脑积水的风险存在差异。 【关键词】开颅夹闭；血管内栓塞；aSAH；慢性脑积水 Influence of the treatment modality used (craniotomy clipping versus endovascular embolization) on the incidence of chronic hydrocephalus after ruptured intracranial?aneurismal SAH 【Abstract】 Objectives To compare the influence of different treatment methods (clipping versus coiling) on the rate of chronic hydrocephalus development after ruptured intracranial?aneurismal SAH; to discus the relationship between aneurismal location and incidence of chronic hydrocephalus. Methods We retrospectively reviewed the medical records of all 857 aneurysmal SAH patients met the inclusive criteria. Patients were divided into 2 groups: group A, patients with surgical?clipping treatment; group B, patients with endovascular embolization. The data of incidence of chronic hydrocephalus was analyzed statistically. Results Of 205 aneurysmal SAH patients, craniotomy coiling was performed on 297 and endovascular embolization on 560 patients. The incidence of chronic hydrocephalus was 10.1% In group A, while 16.8% in group B. The incidence of chronic hydrocephalus for patients with anterior communicating artery (ACoA) aneurysm、posterior communicating artery (PCoA) aneurysm and middle cerebral artery (MCA) aneurysms was 13.8%，13.6% and 6.9% respectively, the difference was not statistically significant. Conclusion The study indicates that endovascular embolization of ruptured intracranial aneurysms has a higher risk of developi