摘要
目的探讨开颅血管搭桥联合介入栓塞治疗小脑后下动脉动脉瘤(posterior inferior cerebellar artery aneurysms,PICAA)疗效及对神经损伤因子、预后的影响。方法选取郑州大学第一附属医院2019年3月至2022年10月PICAA者81例,按照治疗术式不同分成联合组(41例)与栓塞组(40例)。栓塞组接受介入栓塞治疗,联合组接受开颅血管搭桥+介入栓塞治疗,统计对比两组疗效、预后、围术期指标[术中出血量、住院时长、手术时长]以及术前、术后1 d神经损伤因子[神经元特异性烯醇化酶(NSE)、星形胶质源性蛋白(S100β)]、免疫功能[CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)]、血清因子[基质金属蛋白酶-9(MMP-9)、核因子-κB(NF-κB)、细胞间黏附分子-1(ICAM-1)]。结果联合组疗效优于栓塞组,且GOS评分高于栓塞组(P<0.05);与栓塞组相比,联合组住院时长、手术时长明显延长,术中出血量明显增多(P<0.05);术后1 d联合组血清S100β、NSE水平略高于栓塞组,但两组之间无明显差异(P>0.05);术后1 d联合组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)略低于栓塞组,但差异无统计学意义(P>0.05);术后1 d联合组血清MMP-9、ICMA-1、NF-κB水平少于栓塞组(P<0.05)。结论开颅血管搭桥联合介入栓塞治疗PICAA患者效果明显,可有效保护脑神经,减轻炎症反应。
Objective To investigate the efficacy of open vascular bypass+interventional embolization in the treatment of posterior inferior cerebellar artery aneurysm(PICAA)and its effect on neurological injury factors and prognosis.Methods Eighty-one patients with PICAA admitted to our hospital between March 2019 and October 2022 were selected as study subjects and divided into a combined group(41 cases)and an embolization group(40 cases)according to different treatment protocols.The embolization group received interventional embolization and the combination group received open vascular bypass and interventional embolization.The efficacy,prognosis,perioperative indicators[intraoperative bleeding,length of hospital stay,duration of surgery]and preoperative and 1 d postoperative neurological damage factors[neuron-specific enolase(NSE),astroglial-derived protein(S100β)],immune function[CD3^(+),CD4^(+),CD4^(+)/CD8^(+)],serum factors[matrix metalloproteinase-9(MMP-9),nuclear factor-κB(NF-κB),intercellular adhesion molecule-1(ICAM-1)].Results The combined group had better efficacy than the embolization group,and the GOS score was higher than that of the embolization group(P<0.05);Compared with the embolization group,the length of hospitalization and duration of surgery were significantly longer in the combined group,and intraoperative bleeding was significantly higher(P<0.05);serum S100βand NSE levels were slightly higher in the combined group than in the embolization group 1 d after surgery,but there was no significant difference between the two groups(P>0.05);1 d after surgery CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)were slightly lower in the combined group than in the embolization group,but the difference was not statistically significant(P>0.05);Serum MMP-9,ICMA-1 and NF-κB levels were lower in the combined group than in the embolization group 1 d after surgery(P<0.05).Conclusion Cranial vascular bypass combined with interventional embolization is effective in treating patients with PICAA,which can effectively protect brain n
作者
王文德
王天恩
张青德
高鹏
WANG Wen-de;WANG Tian-en;ZHANG Qing-de;GAO Peng(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《医药论坛杂志》
2024年第8期869-872,877,共5页
Journal of Medical Forum
关键词
开颅血管搭桥
介入栓塞
PICAA
神经损伤
Cranial vascular bypass
Interventional embolization
PICAA
Neurological injury
