中国现代手术学杂志2025，Vol.29Issue(2)：119-125,7.DOI:10.16260/j.cnki.1009-2188.2025.02.006
显微手术夹闭与血管内介入栓塞治疗低分级动脉瘤性蛛网膜下腔出血的临床效果分析
Microsurgical clipping versus endovascular coiling for aneurysmal subarachnoid hemorrhage in patients with Hunt-Hess grades 0-Ⅲ:analysis of therapeutic outcomes
摘要
Abstract
Objective To compare the efficacy and safety of microsurgical clipping versus endovascular coiling for aneurysmal subarachnoid hemorrhage(aSAH)in patients with Hunt-Hess grades 0-Ⅲ.Methods A retrospective analysis was conducted on 87 aSAH patients treated in our hospital between January 2018 and December 2022.According to surgical procedure,patients were stratified into a clipping group(42 patients with 44 aneurysms)who underwent microsurgical clipping and an embolization group(45 patients with 49 aneu-rysms)who received endovascular coiling.Complete aneurysm occlusion rates,clinical outcomes at 3 months postoperatively,complications,and intracranial aneurysm(IAN)recurrence rates during follow-up were compared between the two groups.Results Both groups successfully completed the procedures without intra-operative mortality.The mean hospital stay was significantly shorter in the clipping group(18.4±5.2)days than in the embolization group(21.5±5.9)days(P＜0.05).However,no statistically significant differences were observed between the two groups in either complete occlusion rates(81.8％vs.75.5％)or favorable outcome rates at 3 months postoperatively(50.0％vs.57.8％)(P＞0.05).In the clipping group,two patients with anterior communicating artery aneurysms and one with multiple aneurysms died postoperatively due to diffuse cerebral edema with herniation.In the embolization group,two anterior communicating artery aneurysm patients died from postoperative cerebral herniation,one posterior communicating artery aneurysm patient succumbed to massive cerebral infarction,and one middle cerebral artery aneurysm patient died from hemor-rhage secondary to aneurysm recurrence.The clipping group experienced one intraoperative IAN rupture.Postoperative complications included cerebral vasospasm(12 cases),cerebral infarction(2 cases),cerebral edema(6 cases),rebleeding(3 cases),and intracranial infection(1 case).In the embolization group,two intraoperative IAN ruptures occurred.Postoperative complications comprised parent artery stenosis(2 cases),cerebral vasospasm(10 cases),cerebral infarction(3 cases),cerebral edema(4 cases),and rebleeding(3 cases).No significant differences in complication rates were found between the groups(P＞0.05).During a follow-up period of 11 to 37 months postoperatively,the recurrence rate was 2.3％(1/44)in the clipping group and 12.2％(6/44)in the embolization group,with no statistically significant difference between the two groups(P＞0.05).Conclusions Both microsurgical clipping and endovascular embolization with coiling demonstrated comparable efficacy and safety in treating low-grade aSAH.However,endovascular embolization showed a tendency toward higher long-term recurrence rates,potentially warranting intensified long-term surveillance in these patients.关键词
颅内动脉瘤/蛛网膜下腔出血/显微夹闭手术/血管内介入栓塞术/复发Key words
intracranial aneurysm/subarachnoid hemorrhage/microsurgical clipping/endovascular embolization/recurrence引用本文复制引用
王洪波,马鹤,韩允,肖翠,赵端允,李进军,李文帅,张全忠,王奉淼..显微手术夹闭与血管内介入栓塞治疗低分级动脉瘤性蛛网膜下腔出血的临床效果分析[J].中国现代手术学杂志,2025,29(2):119-125,7.基金项目
山东省医药卫生科技发展计划项目(202004040279) （202004040279）
