不同手术策略治疗颅内多发动脉瘤的临床疗效对比

目的 比较不同手术策略治疗颅内多发动脉瘤的疗效，为临床实际工作中治疗颅内多发动脉瘤提供手术策略方面的参考。方法 回顾性分析2011年8月～2020年12月中国医科大学附属盛京医院三个神经外科病房收治的70例手术治疗颅内多发动脉瘤患者的临床资料，将全部病例根据开颅夹闭术或介入栓塞术、单侧或双侧手术、一期或分期手术、处理责任动脉瘤或处理全部动脉瘤进行分组。通过对术后GOS评分、术后再出血情况、术后并发症等预后指标对比分析不同手术策略下的治疗效果。结果 单因素分析中，介入栓塞术的临床疗效好于开颅夹闭术，处理全部动脉瘤临床疗效好于只处理责任动脉瘤；手术侧别、手术分期对预后的影响比较差异无统计学意义（P＞0.05）。多因素分析结果显示，术前Hunt Hess评分及术式的选择是影响预后的独立危险因素。结论 对于多发动脉瘤的治疗，应在条件允许的情况下优先考虑血管内介入治疗，在处理明确诊断的多发动脉瘤时应尽可能处理全部动脉瘤，对于未破裂动脉瘤的处理应遵循一定原则。

Clinical analysis of different surgical strategies for multiple intracranial aneurysms intracranial aneurysms

Objective To compare the efficacy of different surgical strategies in the treatment of multiple intracranial aneurysms, and provide reference for the treatment of multiple intracranial aneurysms in clinical practice. Methods The clinical data of 70 patients with multiple intracranial aneurysms treated in three neurosurgical wards of Shengjing Hospital Affiliated to China Medical University from August 2011 to December 2020 were retrospectively analyzed. All cases were grouped according to craniotomy or interventional embolization, unilateral or bilateral surgery, primary or staging surgery, management of responsible aneurysms, or management of all aneurysms. The therapeutic effects of different surgical strategies were analyzed by comparing the postoperative GOS score, postoperative rebleeding, postoperative complications and other prognostic indicators. Results In univariate analysis, the clinical efficacy of endovascular coiling was better than that of intracranial clipping, and the clinical efficacy of dealing all aneurysms was better than that of only dealing with responsible aneurysms. The influence of surgical side and surgical stage on prognosis was not statistically significant. The postoperative rebleeding and postoperative complications were not statistically significant; In multivariate analysis, preoperative Hunt-Hess scores and the choice of surgical method were the independent risk factors affecting the prognosis the disease. Conclusion For the treatment of multiple aneurysms, endovascular coiling should be chossen priority. In the treatment of multiple aneurysms with definite diagnosis, all aneurysms should be treated as far as possible. The treatment of unruptured aneurysms should follow certain principles.