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目的探讨栓塞体积比(VER)在评价电解可脱性弹簧圈(GDC)栓塞颅内动脉瘤疗效中的作用。方法对在国内7家医院应用GDC栓塞、治疗期≥3年、直径>2 mm的囊状动脉瘤患者,进行临床和影像学随访,共434例(446个动脉瘤)。根据填入动脉瘤内的弹簧圈体积与动脉瘤体积,计算动脉瘤VER。分析VER值与动脉瘤大小、瘤颈、栓塞结果、复发及再出血的关系。结果①小动脉瘤(<5 mm)、中型动脉瘤(5~10 mm)、大动脉瘤(11~25 mm)、巨大动脉瘤(>25 mm)的VER分别为(29±7)%、(24±7)%、(18±9)%和(8±7)%,不同大小动脉瘤患者之间的VER值差异有统计学意义(F=39.70,P<0.01);动脉瘤大小与VER值呈负相关(r=-0.50,P<0.01)。窄、宽颈动脉瘤的VER值分别为(24±8)%、(20±9)%,差异有统计学意义(P=0.001)。②446个动脉瘤的VER为(24±8)%。动脉瘤完全栓塞、颈残留、体部残留患者的VER分别为(28±7)%、(23±7)%及(13±5)%,三者比较差异有统计学意义(F=150.71,P<0.01),且栓塞程度与VER值呈正相关(r=0.57,P<0.01)。③术后临床随访>3年,15个动脉瘤再出血,再出血者动脉瘤VER值为(16±9)%,无再出血者为(24±8)%,P<0.01。④对357个动脉瘤进行DSA随访,中位随访期为16个月;动脉瘤保持稳定298个(83.5%),VER为(25±8)%,复发59个(16.5%),VER为(20±7)%,P<0.01。⑤VER是动脉瘤术后再出血和复发的主要影响因素(OR:0.00,95%CI:0.00~0.08;OR:0.001,95%CI:0.00~0.03)。结论VER是评价动脉瘤栓塞程度的客观指标,对于栓塞术后动脉瘤的复发和再出血具有一定的预测意义。
Objective To investigate the role of embolic volume ratio (VER) in assessing the efficacy of intracranial aneurysm embolization with detachable coils (GDC). Methods A total of 434 patients (446 aneurysms) undergoing GDC embolization at a hospital in China for 3 years or more and with diameter> 2 mm were followed up clinically and radiologically. The aneurysm VER was calculated according to the volume of the coil filled in the aneurysm and the aneurysm volume. The relationship between VER and aneurysm size, tumor neck, embolization, recurrence and rebleeding were analyzed. Results The VER of small aneurysm (<5 mm), medium aneurysm (5 ~ 10 mm), aortic aneurysm (11-25 mm) and giant aneurysm (> 25 mm) were 29 ± 7% (18 ± 9)% and (8 ± 7)% respectively. There was significant difference in VER between different size aneurysms (F = 39.70, P <0.01) Value was negatively correlated (r = -0.50, P <0.01). VER values of narrow and wide-necked aneurysms were (24 ± 8)% and (20 ± 9)%, respectively, with significant difference (P = 0.001). ② The VER of 446 aneurysms was (24 ± 8)%. The VER of patients with complete aneurysm embolization, residual neck and residual body were (28 ± 7)%, (23 ± 7)% and (13 ± 5)%, respectively. There was significant difference among the three groups (F = 150.71, P <0.01). The degree of embolism was positively correlated with VER (r = 0.57, P <0.01). ③ The clinical follow-up> 3 years, 15 aneurysms rebleeding, re-bleeding aneurysm VER value was (16 ± 9)%, no rebleeding (24 ± 8)%, P <0.01. ④ The 357 aneurysms were followed up for 16 months with a median follow-up of 16 months. The aneurysm was stable at 298 (83.5%) with VER of (25 ± 8)%, recurrence of 59 (16.5%) and VER of ( 20 ± 7)%, P <0.01. ⑤VER is the main influencing factor for postoperative hemorrhage and recurrence of aneurysm (OR: 0.00,95% CI: 0.00-0.08; OR: 0.001,95% CI: 0.00-0.03). Conclusion VER is an objective index to evaluate the degree of aneurysm embolization, which has some predictive value for the recurrence and rebleeding of aneurysm after embolization.