脑供血动脉联合重建术治疗大脑中动脉重度狭窄或闭塞  

Preliminary clinical study of combined extra-intracranial feeding arteries reconstruction for severe middle cerebral artery stenosis or occlusion

作　　者：李东波[1] 宋冬雷[1] 顾宇翔[1] 徐斌[1] 冷冰[1] 王启弘[1] 陈功[1] 陈亮[1] 田彦龙[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040

出　　处：《中华神经外科疾病研究杂志》2009年第2期161-165,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：上海市科学技术委员会科研基金资助项目(批准号074119504)

摘　　要：目的探讨外科手术治疗大脑中动脉重度狭窄或闭塞所致缺血性脑血管病。方法对9例有症状的大脑中动脉重度狭窄或闭塞所致缺血性脑血管病患者进行了颞浅动脉-大脑中动脉吻合结合脑-硬脑膜-肌肉血管融合术(脑供血动脉联合重建术),分析围手术期前后及随访的症状体征和脑血流变化情况。结果全组病例手术均顺利完成。术后随访7例,随访时间6～24个月,平均12个月,症状均较术前好转或消失:7例患者术前美国国立卫生研究院卒中量表(NIHSS)总分为14分,随访时下降到3分,术前改良Rankin量表(MRS)总分为13分,随访时下降到4分。结论在严格选择适应证患者中,脑供血动脉联合重建术治疗大脑中动脉重度狭窄或闭塞效果基本满意。CT灌注作为一种脑血流评估方法,在大脑中动脉重度狭窄或闭塞患者手术前病例筛选和手术后疗效评估方面很有价值。Objective To investigate the surgical treatment for ischemic cerebrovascular disease due to severe middle cerebral artery stenosis or occlusion. Methods A total of 9 patients who suffered symptomatic ischemic cerebrovascular disease due to severe middle cerebral artery stenosis or occlusion were operated with superficial temporal artery-middle cerebral artery anastomosis combined with encephaloduromyosynangiosis （combined extra-intracranial feeding arteries reconstruction operation）. The perioperative and follow-up diversity of symptoms, signs and cerebral blood flow were all analyzed. Results All operations were successful. Seven patients were followed-up from 6 months to 24 months （average 12 months）. Ischemic symptoms improved or disappeared： the total score of 7 patients was 14 points （National Institutes of Health Stroke Scale, NIHSS）before surgery and descended to 3 points in follow-up; the total preoperative Modified Rankin Scale （MRS） scores was 13 points and it descended to 4 points. Conclusion Combined extra-intracranial feeding arteries reconstruction is good for the patients with strict operation indication. CT perfusion is very valuable in the CBF investigation preoperatively and postoperatively.

关 键 词：大脑中动脉 血管狭窄 缺血性脑血管病 颅内外血管吻合 CT灌注 

分 类 号：R743.2[医药卫生—神经病学与精神病学]