[1]申汉威　李俊卿　李红星　汪立刚　杨孔宾.颅内破裂动脉瘤夹闭术与血管内栓塞术后脑积水发生率的比较分析[J].中国临床神经外科杂志,2015,(03):140-143.[doi:10.13798/j.issn.1009-153X.2015.03.004]
　SHEN Han-wei,LI Jun-qing,LI Hong-xing,et al.Clinical study and Meta-analysis of incidences of hydrocephalus after microsurgery and endovascular embolization in patients with ruptured intracranial aneurysms[J].,2015,(03):140-143.[doi:10.13798/j.issn.1009-153X.2015.03.004]
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颅内破裂动脉瘤夹闭术与血管内栓塞术后脑积水发生率的比较分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2015年03期
页码:
140-143
栏目:
论著
出版日期:
2015-03-30

文章信息/Info

Title:
Clinical study and Meta-analysis of incidences of hydrocephalus after microsurgery and endovascular embolization in patients with ruptured intracranial aneurysms
文章编号:
1009-153X（2015）03-0140-04
作者:
申汉威　李俊卿　李红星　汪立刚　杨孔宾
150001 哈尔滨，哈尔滨医科大学附属第一临床学院神经外科
通讯作者：杨孔宾，E-mail：ykbneurosurgery@sina.com
Author(s):
SHEN Han-wei;  LI Jun-qing;  LI Hong-xing;  WANG Li-gang;  YANG Kong-bin.
Department of Neurosurgery, the First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
关键词:
颅内破裂动脉瘤; 脑积水; 开颅夹闭术; 血管内栓塞术; 荟萃分析
Keywords:
Intracranial ruptured aneurysm;  Hydrocephalus;  Craniotomy clipping;  Endovascular embolization;  Meta analysis
分类号:
R 743.9; R 619
DOI:
10.13798/j.issn.1009-153X.2015.03.004
文献标志码:
A
摘要:
目的 评价不同治疗方法对动脉瘤性蛛网膜下腔出血（aSAH）患者分流依赖性脑积水发生率的影响。方法 回顾性分析2012年1月至2013年12月我院收治的557例aSAH患者的临床资料，其中夹闭术治疗291例，血管内栓塞术治疗266例；另外，通过计算机检索国内外数据库，并对符合标准的文献应用Review Manager 5.2软件进行Meta分析，系统评价夹闭术和血管内栓塞术对aSAH患者术后分流依赖性脑积水发生率的影响。结果 本组开颅夹闭术组分流依赖性脑积水发生率（46.7%，91/291）与血管内栓塞术组（53.3%，104/266）无显著差异（P>0.05）；脑室内出血和急性脑积水对两种治疗方式术后分流依赖性脑积水发生率无显著影响（P>0.05）。Meta分析共纳入符合要求文献9篇包含5 093例患者，其中开颅夹闭术组3 340例，血管内栓塞术组1 612例。两组治疗方法术后分流依赖性脑积水发生率无显著差异[优势比（OR）=0.84；95%可信区间（CI）为0.64~1.12；P=0.24]。对于存在脑室内出血的aSAH患者，血管内栓塞术后发生分流依赖性脑积水的几率明显降低（OR=0.56；95% CI为0.35~0.90；P=0.02）。结论 对于存在脑室内出血的aSAH患者，建议行血管内栓塞术治疗，有助于降低术后分流依赖性脑积水的几率。
Abstract:
Objective To assess the effects of microsurgery and endovascular embolization on the incidence of hydrocephalus in the patients ruptured intracranial aneurysms. Method The clinical data of 557 patients with ruptured intracranial aneurysms, of whom, 291 underwent craniotomy and 266 endovascular embolization from January, 2012 to December, 2013, were analyzed retrospectively. The databases at home and abroad were searched by the computer for the literatures related to the hydrocephalus after the microsurgery or endovascular embolization in the patients with ruptured intracranial aneurysms. All the acquired data were analyzed by Review Manager 5.2 software. Results Of 291 patients undergoing the craniotomy, 91 (31.29%) suffered from the shunt-dependent hydrocephalus and 200 not. Of 266 patients undergoing endovascular embolization, 104 (39.10%) suffered from shunt-dependent hydrocephalus and 162 not. There was insignificant difference in the hydrocephalus incidence between both the groups. Meta analysis showed that there was insignificant difference in the incidence of shunt-dependent hydrocephalus between the patients with ruptured intracranial aneurysms undergoing craniotomy and ones undergoing endovascular embolization, and the intraventricular hemorrhage (IVH) was very risk factor of the hydrocephalus in the patients with ruptured intracranial aneurysms undergoing endovascular embolization. Conclusion Generally speaking, the incidence of shunt-dependent hydrocephalus is not influenced by treatment Methods including microsurgery and endovascular embolization in the patients with ruptured intracranial aneurysms except the patients with IVH after the aneurysms ruptured.

参考文献/References:

[1] Varelas P, Helms A, Sinson G, et al. Clipping or coiling of ruptured cerebral aneurysms and shunt-dependent hydro- cephalus [J]. Neurocrit Care, 2006, 4: 223-228.
[2] Dorai Z, Hynan LS, Kopitnik TA, et al. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage [J]. Neurosurgery, 2003, 52: 763-771.
[3] GruberA, Reinprecht A, Bavinzski G, et al. Chronic shunt- dependent hydrocephalus after early surgical and early endovascular treatment of ruptured intracranial aneurysms [J]. Neurosurgery, 1999, 44: 503-509.
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更新日期/Last Update: 2015-03-30