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目的:比较显微外科夹闭术和血管内治疗大脑中动脉分叉处动脉瘤(MbifAs)的临床疗效。方法:回顾性分析2015年1月至2019年6月宁夏医科大学总医院神经外科收治的190例MbifAs患者的临床资料。根据治疗方式将患者分为血管内治疗组(52例)和显微外科夹闭术组(138例)。根据术后并发症发生率、颅内动脉瘤复发率及颅内动脉瘤再破裂率评估手术疗效。出院后采用电话或门诊的方式对患者进行随访。至末次随访，采用改良Rankin量表评分(mRS)评估患者预后，其中0～2分定义为预后良好，3～6分为预后不良。结果:190例患者的手术均成功。术后并发症包括，肺部感染70例(36.8%)、颅内感染92例(48.4%)、脑疝形成14例(7.4%)。190例患者的随访时间为(16.2±6.3)个月(1～52个月)。至末次随访，151例(79.5%)患者预后良好，另39例(20.5%)预后不良。两组的性别、年龄、合并吸烟史、高血压史、入院格拉斯哥昏迷评分、改良Fisher分级、破裂动脉瘤的世界神经外科联盟分级及颅内动脉瘤大小的差异均无统计学意义(均n P>0.05)。与显微外科夹闭术组比较，血管内治疗组的宽颈动脉瘤[分别为38.4%(53/138)、15.4%(8/52)]、破裂动脉瘤[分别为82.6%(114/138)、67.3%(35/52)]及联合去骨瓣减压术[分别为33.3%(46/138)、3.8%(2/52)]的占比均低(均n P0.05). Compared with the clipping group, the coiling group had a lower proportion of wide-neck aneurysms [15.4% (8/52)n vs. 38.4% (53/138)], lower proportion of ruptured aneurysms [67.3% (35/52) n vs. 82.6% (114/138)] and lower rate of combined conduction of decompressive craniectomy [3.8% (2/52) n vs. 33.3% (46/138)] (all n P<0.05), lower incidences of postoperative lung infection [21.2% (11/52)n vs. 42.8% (59/138)] and intracranial infection [3.8% (2/52) n vs. 65.2% (90/138)] were lower (both n P<0.05), shorter length of hospital stay [median (range): 17.5 (13.3-23.5) dn vs. 22.5 (18.0-30.0) d, n P<0.05], and a higher rate of recurrence [9.6% (5/52)n vs. 0.8% (1/138), n P0.05).n Conclusions:Endovascular therapy has the advantages of lower postoperative incidences of lung infection and intracranial infection as well as shorter hospital stay than microsurgical clipping. However, it should be noted that the recurrence rate in the embolization group seems higher than that in the clipping group and similar outcomes are associated with both modalities.