目的:已知性别之间的流行病学和动脉瘤生长速度的差异。然而,对未破裂颅内动脉瘤(UIAs)显微手术夹闭后的性别依赖性结局知之甚少.这项研究的目的是检查UIAs显微外科手术后特征和结果的性别差异,并使用国际多中心队列进行倾向评分匹配分析。
方法:这项回顾性队列研究涉及四大洲15个中心的参与。它包括在2016年1月至2020年12月期间接受UIAs剪裁的成年患者。根据患者的性别进行分层,并分析发病率和动脉瘤特征的差异。基于这种分层,女性患者与男性患者的匹配比例为1:1,卡钳宽度为0.1,采用倾向评分匹配法.终点包括术后并发症,神经表现,出院时和夹后24个月动脉瘤闭塞。
■共纳入2245例患者,平均年龄为57.3岁(范围20-87岁)。在这些病人中,1675(74.6%)为女性。女性患者明显年龄较大(平均57.6岁vs56.4岁,p=0.03),但合并症较少。颈内动脉动脉瘤(7.1%vs4.2%),后交通动脉(6.9%vs1.9%),眼动脉(6.0%vs2.8%)更常见于女性手术治疗,而前交通动脉瘤的夹闭在男性中更为常见(17.0%vs25.3%;所有p<0.001)。在倾向得分匹配后,发现女性患者的肺部并发症明显较少(1.4%vs4.2%,p=0.01)。然而,一般发病率(24.5%vs25.2%,p=0.72)和死亡率(0.5%vs1.1%,p=0.34),以及神经系统表现(p=0.58),出院时男女都相当。最后,出院时动脉瘤闭塞率(95.5%vs94.9%,p=0.71)和手术后24个月(93.8%vs96.1%,p=0.22)在男性和女性患者之间没有显着差异。
结论:尽管男性和女性患者在人口统计学上存在总体差异,合并症,和治疗的动脉瘤位置,性别对手术性能或围手术期并发症发生率无相关影响.
OBJECTIVE: Disparities in the epidemiology and growth rates of aneurysms between the sexes are known. However, little is known about sex-dependent outcomes after
microsurgical clipping of unruptured intracranial aneurysms (UIAs). The aim of this study was to examine sex differences in characteristics and outcomes after
microsurgical clipping of UIAs and to perform a propensity score-matched analysis using an international multicenter cohort.
METHODS: This retrospective cohort study involved the participation of 15 centers spanning four continents. It included adult patients who underwent clipping of UIAs between January 2016 and December 2020. Patients were stratified according to their sex and analyzed for differences in morbidities and aneurysm characteristics. Based on this stratification, female patients were matched to male patients in a 1:1 ratio with a caliper width of 0.1 using propensity score matching. Endpoints included postoperative complications, neurological performance, and aneurysm occlusion at discharge and 24 months after clip placement.
UNASSIGNED: A total of 2245 patients with a mean age of 57.3 (range 20-87) years were included. Of these patients, 1675 (74.6%) were female. Female patients were significantly older (mean 57.6 vs 56.4 years, p = 0.03) but had fewer comorbidities. Aneurysms of the internal carotid artery (7.1% vs 4.2%), posterior communicating artery (6.9% vs 1.9%), and ophthalmic artery (6.0% vs 2.8%) were more commonly treated surgically in females, while clipping of aneurysms of the anterior communicating artery was more frequent in males (17.0% vs 25.3%; all p < 0.001). After propensity score matching, female patients were found to have had significantly fewer pulmonary complications (1.4% vs 4.2%, p = 0.01). However, general morbidity (24.5% vs 25.2%, p = 0.72) and mortality (0.5% vs 1.1%, p = 0.34), as well as neurological performance (p = 0.58), were comparable at discharge in both sexes. Lastly, rates of aneurysm occlusion at the time of discharge (95.5% vs 94.9%, p = 0.71) and 24 months after surgery (93.8% vs 96.1%, p = 0.22) did not significantly differ between male and female patients.
CONCLUSIONS: Despite overall differences between male and female patients in demographics, comorbidities, and treated aneurysm location, sex did not relevantly affect surgical performance or perioperative complication rates.