發(fā)布時(shí)間：2018-10-05 21:54

【摘要】：研究目的:通過觀察LVIS(Low-profile visible intraluminal support device)支架輔助彈簧圈栓塞顱內(nèi)動(dòng)脈瘤,探討LVIS支架輔助彈簧圈栓塞顱內(nèi)動(dòng)脈瘤的安全性、有效性及預(yù)后相關(guān)因素,為臨床應(yīng)用LVIS支架輔助彈簧圈治療顱內(nèi)動(dòng)脈瘤提供理論依據(jù)。研究方法:選取2014年-2016年于山東省濟(jì)寧市第一人民醫(yī)院神經(jīng)血管外科應(yīng)用LVIS支架輔助彈簧圈介入栓塞治療的顱內(nèi)動(dòng)脈瘤患者共54例,整理和收集所有治療患者的一般資料(包括患者的發(fā)病年齡、性別、是否患有高血壓病、動(dòng)脈瘤的部位、術(shù)前的H-H分級(jí))、影像學(xué)資料、圍手術(shù)期并發(fā)癥、治療效果(動(dòng)脈瘤栓塞程度)、隨訪資料(MRS預(yù)后評(píng)分和復(fù)發(fā)率),采用SPSS17.0統(tǒng)計(jì)軟件對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)分析,評(píng)價(jià)LVIS支架輔助彈簧圈栓塞顱內(nèi)動(dòng)脈瘤的安全性和有效性及預(yù)后相關(guān)因素。研究結(jié)果:術(shù)后即刻栓塞程度用Raymond標(biāo)準(zhǔn)評(píng)估,58枚動(dòng)脈瘤100%完全栓塞56枚,95%-99%次完全栓塞2枚,小于95%不完全栓塞0枚。寬頸和窄頸動(dòng)脈瘤在即刻栓塞程度上無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。發(fā)生圍手術(shù)期并發(fā)癥7例,術(shù)中發(fā)生破裂出血2例,術(shù)中血栓形成1例,支架移位1例,腦積水3例�？傮w并發(fā)癥發(fā)生率為13.0%。寬頸和窄頸動(dòng)脈瘤圍手術(shù)期并發(fā)癥發(fā)生率無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05),患者有無(wú)高血壓圍手術(shù)期并發(fā)癥發(fā)生率無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。Rankin改良預(yù)后評(píng)分(mRS評(píng)分)評(píng)價(jià)出院轉(zhuǎn)歸,0-2分級(jí)50例,3-6分4例。均經(jīng)過3-12個(gè)月的隨訪,均經(jīng)DSA復(fù)查,其中復(fù)發(fā)2例。有無(wú)高血壓的患者預(yù)后及復(fù)發(fā)率之間無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05),寬頸和窄頸動(dòng)脈瘤的預(yù)后及復(fù)發(fā)率之間無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。研究結(jié)論:LVIS支架輔助彈簧圈栓塞顱內(nèi)動(dòng)脈瘤是一種安全有效的治療方法,LVIS支架適合顱內(nèi)不同部位動(dòng)脈瘤的輔助栓塞治療,對(duì)各種類型動(dòng)脈瘤都有很好的治療效果。高血壓對(duì)于LVIS支架輔助彈簧圈栓塞顱內(nèi)動(dòng)脈瘤的預(yù)后及復(fù)發(fā)無(wú)影響。LVIS支架輔助彈簧圈栓塞治療顱內(nèi)寬頸和窄頸動(dòng)脈瘤的栓塞程度、并發(fā)癥及復(fù)發(fā)比例無(wú)明顯差異。
[Abstract]:Objective: to investigate the safety, efficacy and prognostic factors of LVIS (Low-profile visible intraluminal support device) stent assisted coils) for embolization of intracranial aneurysms. To provide a theoretical basis for the clinical application of LVIS stent assisted coils in the treatment of intracranial aneurysms. Methods: a total of 54 patients with intracranial aneurysms who were treated with LVIS stent-assisted coils in neurovascular surgery from 2014 to 2016 in the first people's Hospital of Jining, Shandong Province, were selected. Collate and collect general data of all patients (including age, sex, hypertension, location of aneurysm, H-H grade before operation), imaging data, perioperative complications, The results of treatment (degree of embolization of aneurysm), follow-up data (MRS prognosis score and recurrence rate) were analyzed by SPSS17.0 software to evaluate the safety, efficacy and prognostic factors of LVIS stent-assisted coils for embolization of intracranial aneurysms. Results: the degree of embolization in 58 aneurysms was evaluated by Raymond standard immediately after operation. 56 aneurysms were completely embolized by 100%, 56 aneurysms were completely embolized, 56 aneurysms were completely embolized by 95% embolization, 2 aneurysms were completely embolized, and 0 aneurysms were less than 95% incomplete embolization. There was no significant difference in the degree of immediate embolization between wide neck and narrow carotid aneurysms (P0.05). Perioperative complications occurred in 7 cases, rupture and hemorrhage in 2 cases, thrombosis in 1 case, stent displacement in 1 case, hydrocephalus in 3 cases. The overall incidence of complications was 13.0. There was no significant difference in the incidence of perioperative complications between wide neck aneurysms and narrow carotid aneurysms (P0.05). There was no significant difference in the incidence of perioperative complications in patients with hypertension (P0.05). Rankin improved prognosis score (mRS score) was used to evaluate the outcome of discharge. 50 cases were divided into 3-6 points and 4 cases were classified. All of them were followed up for 3-12 months, all of them were reexamined by DSA. There was no significant difference in prognosis and recurrence rate between patients with or without hypertension (P0.05), while there was no significant difference in prognosis and recurrence rate between wide neck and narrow carotid aneurysms (P0.05). Conclusion it is a safe and effective method to embolize intracranial aneurysms with the help of the: LVIS stent-assisted coils. LVIS stent is suitable for different parts of intracranial aneurysms and has a good therapeutic effect on various types of aneurysms. Hypertension had no effect on the prognosis and recurrence of embolization of intracranial aneurysms with LVIS stent-assisted coils. There was no significant difference in the degree of embolization of intracranial aneurysms with wide neck and narrow carotid aneurysms, and there was no significant difference in the rate of complications and recurrence.
【學(xué)位授予單位】：濟(jì)寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.12

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