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目的探讨电解可脱性微弹簧圈(GDC)血管内栓塞治疗颅内小动脉瘤性蛛网膜下腔出血的患者预后。方法本组63例均证实为颅内小动脉瘤性蛛网膜下腔出血,均行GDC血管内栓塞治疗,观察GDC血管内栓塞治疗并发症的发生情况,栓塞结束后临床随访结果和影像学随访结果。观察患者性别、年龄、动脉瘤部位、Hunt-Hess分级、F isher分级、症状性脑血管痉挛、手术时间、急性脑积水程度、迟发性脑积水程度、术后颅内压力与临床预后的关系。结果63例患者中,栓塞治疗中1例弹簧圈部分脱出瘤腔,无术中动脉瘤破裂和无动脉栓塞或血栓发生。临床随访恢复良好39例,轻、中度残疾22例,重度残疾或死亡2例,均无栓塞后动脉瘤再次破裂出血;影像学随访42例,1例动脉瘤栓塞术后瘤颈复发,41例动脉瘤均保持手术栓塞结束当时的状态。影响患者临床预后因素依次是:①症状性脑血管痉挛;②发病后的Hunt-Hess分级;③术后颅内压力。结论GDC血管内栓塞治疗小动脉瘤性蛛网膜下腔出血是安全和有效的治疗方法,症状性脑血管痉挛是影响小动脉瘤性蛛网膜下腔出血预后的决定性因素。
Objective To investigate the prognosis of patients with intracranial aneurysm subarachnoid hemorrhage treated by endovascular embolization with detachable detachable coil (GDC). Methods 63 cases of this group were confirmed as intracranial aneurysm subarachnoid hemorrhage were treated with GDC endovascular treatment of GDC endovascular treatment of complications, clinical follow-up results after embolization and imaging follow-up result. The patient’s gender, age, location of aneurysm, Hunt-Hess grade, F isher grade, symptomatic cerebral vasospasm, operation time, degree of acute hydrocephalus, degree of delayed hydrocephalus, postoperative intracranial pressure and clinical prognosis Relationship. Results Among the 63 patients, one of the coils in the embolization treatment was partially out of the tumor cavity without rupture of the aneurysm and no arterial embolism or thrombus. In the clinical follow-up, there were 39 cases with good recovery, 22 cases with mild or moderate disability, 2 cases with severe disability or death, and no aneurysm ruptured again after embolization. 42 cases were followed up, 1 case had tumor neck recurrence after aneurysm embolization, 41 Cases of aneurysm were to maintain the status of the end of surgery embolization. Clinical prognostic factors affecting patients were: ① symptomatic cerebral vasospasm; ② Hunt-Hess after the onset of grading; ③ postoperative intracranial pressure. Conclusion GDC endovascular treatment of small aneurysmal subarachnoid hemorrhage is a safe and effective treatment. Symptomatic cerebral vasospasm is a determinant factor affecting the prognosis of small aneurysmal subarachnoid hemorrhage.