颅内动脉瘤介入栓塞术后二次复发的影响因素分析

doi:10.3760/cma.j.issn.2095-7041.2019.04.012

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摘要目的探讨颅内栓塞术后复发动脉瘤介入治疗后再复发的影响因素。方法采用回顾性队列研究方法。纳入2010年1月—2016年12月北京市大兴区人民医院神经外科二次介入栓塞术治疗的复发动脉瘤患者69 例,其中男27例、女42 例,年龄25~76(48±10)岁;二次介入手术后再复发13例,再复发率为18.8%(13/69)。采用单因素分析及Logistic回归分析方法, 分析复发颅内动脉瘤介入治疗后再复发的影响因素。结果单因素分析显示,复发组与非复发组患者性别、年龄、合并高血压、合并糖尿病、吸烟、动脉瘤瘤颈宽度、动脉瘤部位、是否支架辅助比较,差异均无统计学意义(P值均＞0.05);而两组患者动脉瘤大小、手术前后改良RANKIN量表(mRS)评分变化情况、术后Raymond分级比较,差异均有统计学意义(Z=-3.396、-5.955、-5.825, P值均＜0.05)。Logistic回归分析显示:以RaymondⅠ级为参照,RaymondⅡ级(OR=0.116,95%CI 0.025~0.546, P＜0.01)和Raymond Ⅲ级(OR=0.052, 95%CI 0.008~0.350, P＜0.01)为二次介入栓塞术后动脉瘤再复发的独立危险因素。结论栓塞不完全(RaymondⅡ级和Ⅲ级)是二次介入栓塞术后动脉瘤再复发的独立危险因素;对于再复发的颅内动脉瘤,二次介入术中选择合适的弹簧圈,尽可能栓塞完全无残留,意味着更低的再复发率。

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	方治军
	张东

关键词 ：颅内动脉瘤, 复发, 栓塞,治疗性, 影响因素分析

Abstract：Objective To explore the influencing factors of recurrence after interventional treatment of recurrent aneurysms after intracranial embolization.Methods The retrospective cross-sectional study was conducted. A total of 69 recurrent aneurysms patients received secondary intervention from January 2010 to December 2016 were retrospectively analyzed, including 27 males and 42 females with age of 25-76(48±10) years. Thirteen patients relapsed after second intervention, and the recurrence rate was 18.8%(13/69). Univariate analysis and further logistic regression analysis were used to analyze the influencing factors of recurrence of recurrent intracranial aneurysms after interventional therapy.Results Univariate analysis showed that there was no significant difference in gender, age, hypertension, diabetes mellitus, smoking, aneurysm neck width, aneurysm site, or stent-assisted combination between the recurrent and non-recurrent groups (all P values ＞0.05).The aneurysm size, the change of the modified RANKIN scale (mRS) score before and after surgery, and the postoperative Raymond grade were statistically significant (Z=-3.396, -5.955, -5.825, all P values＜0.05). Logistic regression analysis showed that Raymond Ⅱ(OR=0.116, 95% CI 0.025-0.546, P＜0.01) and Raymond Ⅲ(OR=0.052, 95% CI 0.008-0.350, P＜0.01) were independent risk factors for recurrence of aneurysms after secondary interventional embolization according with Raymond I as the reference.Conclusions Incomplete embolization (Raymond Ⅱ grade and Ⅲ grade) is an independent risk factor for intracranial aneurysms re-recurrence after interventional embolization. For recurrent intracranial aneurysms, appropriate coil and embolic materials should be selected.Complete embolization without residual during the interventional procedure means lower rate of recurrence.

Key words： Intracranial aneurysm Recurrence Embolization, therapeutic Root cause analysis

收稿日期: 2018-08-08

通讯作者: 张东,Email:zhangdong0660@aliyun.com

引用本文:

方治军, 张东. 颅内动脉瘤介入栓塞术后二次复发的影响因素分析[J]. 中华解剖与临床杂志, 2019, 24(4): 375-379.
Fang Zhijun, Zhang Dong. Analysis of related factors of aneurysm re-recurrence after secondary embolization. Chinese Journal of Anatomy and Clinics, 2019, 24(4): 375-379.

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http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2019.04.012 或 http://www.cjac.com.cn/CN/Y2019/V24/I4/375

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