出血型烟雾病的临床特征及治疗  

Clinical features and treatment of the hemorrhagic moyamoya disease

作　　者：段炼[1] 史万超[1] 赵峰[1] 杨伟忠[1] 冯捷[1] 宗睿[1] 韩聪[1] 张正善[1] 高山[2] 邹丽萍[3] 

机构地区：[1]军事医学科学院附属医院神经外科,北京100071 [2]北京协和医院神经内科 [3]首都医科大学附属北京市儿童医院

出　　处：《中华神经外科杂志》2009年第3期201-204,共4页Chinese Journal of Neurosurgery

基　　金：首都医学发展基金项目（2005-1012）2003-2028

摘　　要：目的分析出血型烟雾病病例的临床特征，探讨烟雾病出血的病因及治疗方法。方法回顾性分析61例出血型烟雾病发病特征、出血部位及类型、脑血管造影特点及治疗结果。结果61例病例中成人57例，以脑出血破入脑室发病居多。52个出血半球存在脉络膜前动脉异常扩张合并后交通动脉扩张。61例患者共行硬脑膜颞浅动脉血管融通术116例次，行硬脑膜枕动脉血管融通术2例次，2例未行手术治疗，后因再发脑出血死亡，手术后无再发出血病例。结论脉络膜前动脉合并后交通动脉扩张是造成烟雾病出血的重要原因之一；行脑硬膜动脉血管融通术可能有益于预防再出血的发生。Objective To study the clinical features, bleeding reasons and strategies of the treatment of 61 patients with hemorrhagic moyamoya disease. Method The clinical features of onset, bleeding location of the lesions and the type, characteristics of DSA images and therapeutic results were studied retrospectively. Results In all 61 patients, 57 patients were adult. Most of them were cerebral hemorrhage breaking into ventricles. In all the hemisphere of hemorrhage, dilatation and abnormal branching of the AChA and P-CoM were observed in 52 patients. 118 procedures of EDAS were performed, including superficial temporal artery in 116 hemispheres and occipital artery in 2 hemispheres. There was no recurrence of hemorrhage in those operation patients. But 2 patients without EDAS died due to recurrence of hemorrhage. Conclusions Dilatation and abnormal branching of the AChA and/or P - CoM are one of the main reasons for hemorrhagic events. The treatment of EDAS may be an effective method for preventing the recurrence of hemorrhage of hemorrhagic moyamoya disease.

关 键 词：脑底异常血管网病 脑出血 脑室出血 

分 类 号：R686[医药卫生—骨科学]