手术与保守治疗烟雾病患者的单中心长期随访观察  

Experience of 97 patients with moyamoya disease： long.term follow-up at a single center

作　　者：刘兴炬[1] 张东[1] 王硕[1] 赵元立[1] 王嵘[1] 赵继宗[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华医学杂志》2012年第9期604-607,共4页National Medical Journal of China

基　　金：国家“十一五”科技支撑计划项目：脑卒中外科综合治疗技术体系研究（2006BAl01A13）

摘　　要：目的探讨手术与保守治疗烟雾病的中长期预后，分析影响预后的相关因素。方法回顾性分析2000年1月至2007年12月北京天坛医院97例烟雾病患者的临床资料，根据治疗方法将患者分成3个组：颞浅动脉一大脑中动脉吻合（STA—MCA）组（n=31），间接血管重建术组（n=38）和保守治疗组（n=28）。随访的主要事件为死亡，再出血，新发脑梗死和短暂性脑缺血发作（TIA）。结果97例患者平均随访（85±38）个月，累计全因死亡6例，其中5例死于再发脑出血，11例患者累计17次再出血，再出血率17．5％。STA·MCA组中23例（74％）患者症状好转，4例症状加重，无死亡及再出血病例；间接血管重建术组中28例（74％）症状有好转，死亡3例，2例死于颅内再出血，症状进展4例；保守组中17例（60％）症状好转，进展7例，9例患者合并15次再出血，其中3例死亡。多因素回归发现治疗方法与患者的长期预后相关，患者的年龄，性别，家族史，单双侧与预后无关（P〉0．05）。手术组的再出血的风险明显低于保守治疗（P〈0．01），而STA—MCA组与间接血管重建组之间差异无统计学意义（P〉0．05）。结论再发脑出血是烟雾病的长期预后不良和致死的主要原因；手术治疗的中期预后好于保守治疗，手术治疗降低了患者再出血的危险性。Objective To explore the medium and long-term outcomes of patients with Moyamoya disease （MD） undergoing surgery and conservative treatment at a single institution and analyze the related prognostic factors. Methods A retrospective review was conducted for 97 MD patients at Beijing Tiantan Hospital from January 2000 to December 2007. They were divided into 3 groups according to treatments： superficial temporal artery-middle cerebral artery （STA-MCA）anastomosis （n = 31 ）, indirect vascular revascularization group （n = 38 ） and conservative treatment group （n = 28 ）. The primary follow-up events included death, recurrent cerebral hemorrhage, new cerebral infarction and transient ischemic attack （TIA）. Results All were available for analysis with the complete follow-up data. The average follow-up period of was 85 -＋38 months. In total, there were 6 deaths with all-cause mortality （6. 1% ）. Among them, 5 （5.1%） patients died from recurrent cerebral hemorrhage. And 17 episodes of rebleeding occurred in 11 patients. Two episodes of intracranial hemorrhage were found in 4 patients. The risk of rebleeding was 17. 5%. In the STA-MCA group, 23（74% ）cases had excellent recovery, 5 eases fared worse and there was no death case. Among the patients undergoing indirect vascular revascularization, 28 cases recovered favorably, 4 cases progressed and 3 cases died. In the conservative treatment group, 17 patients recovered favorably, 7 progressed, 9 experienced 15 episodes of rebleeding and 3 died. Multivariate Cox regression analysis showed that the method of treatment was an independent prognostic factor for MD and surgical revaseularization was superior to conservative treatment. No correlation was found between the patient age, gender, familial history, unilateral or bilateral and prognosis （P 〉 0. 05 ）. Kaplan-Meier stroke risk analysis showed the risk of recurrent hemorrhage in the revascularization surgery group was lower than that in the conservative group. And no difference ex

关 键 词：烟雾病 血管重建术 保守治疗 随访 再出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]