颞浅动脉-大脑中动脉搭桥术在治疗闭塞性脑血管病中的应用  

Application of superficial temporal artery to middle cerebral artery bypass in treatment of cerebral artery steno-occlusive disease

作　　者：段鸿洲[1] 李良[1] 张扬[1] 莫大鹏 伊志强[1] 张家湧[1] 鲍圣德[1] 

机构地区：[1]北京大学第一医院神经外科,北京100034 [2]北京天坛医院脑血管病中心急诊介入科,北京100050

出　　处：《北京大学学报（医学版）》2013年第1期123-128,共6页Journal of Peking University:Health Sciences

基　　金：高等学校博士学科点专项科研基金(20110001120050)资助~~

摘　　要：目的:探讨颞浅动脉-大脑中动脉(superficial temporal artery to middle cerebral artery,STA-MCA)搭桥术在闭塞性脑血管病中的治疗作用。方法:筛选52例存在血流动力学障碍,并且临床上有相应缺血表现的单侧颈内动脉闭塞或单侧大脑中动脉闭塞或moyamoya病患者,应用STA-MCA搭桥术进行治疗。手术前、后通过脑血管造影及CT脑灌注成像对吻合口通畅情况及脑血流动力学变化情况进行评价。手术后对患者进行长期随访,观察相关合并症及有无再发卒中,应用改良Rankin量表(modified Rankin scale,mRS)评定患者手术后神经功能状况。结果:52例患者均成功完成手术,2例术中发现吻合口不通畅,改行颞肌贴附术。术后并发症4例,其中2例为手术侧硬膜下血肿,1例为手术对侧基底节出血,1例为头皮愈合不良。术后造影显示吻合口通畅48例,CT脑灌注图像显示术后病变侧相对脑血流量(relative cerebral blood flow,rCBF)明显增加[(37.79±9.76)mL/(min.100 g)vs.(33.71±7.92)mL/(min.100 g),P<0.05],相对脑血流平均通过时间(relative mean transmit time,rMTT)明显减少[(8.49±1.97)s vs.(11.06±3.00)s,P<0.01]。术后3个月及12个月神经功能mRS评分较术前降低(1.37±0.66 vs.1.58±0.64,0.84±0.57 vs.1.51±0.67,P<0.05)。随访期间未出现手术侧脑卒中发作。结论:对存在脑血流动力学障碍的闭塞性脑血管病患者,STA-MCA搭桥术可以增加患侧脑组织的血流,改善神经功能并预防同侧脑卒中的发生。Objective：To explore the effect of superficial temporal artery to middle cerebral artery （STA-MCA） bypass in treatment of cerebrovascular disease. Methods： Fifty-two patients with athero- sclerotic carotid artery occlusion or middle cerebral artery occlusion or moyamoya disease were included in this study. There were both clinical ischemic manifestation and hemodynamic dysfunction detected by perfusion CT in all the patients. DSA and perfusion CT（PCT） were conducted before and after STA-MCA bypass in order to evaluate the change of hemodynamics and the state of anastomotic astium. The patients were followed-up to know if there was any complication or recurrent stroke. Modified Rankin scale （mRS） was used in assessing the state of neurological function. Results： STA-MCA bypass was per- formed successfully in 50 patients, while anastomotic astium was found to be obstructed in 2 patients during operation and temporalis attachment was conducted immediately. Complications occurred in 4 pa- tients, 2 with subdural hematoma, 1 with hematoma in contralateral basal ganglia, and 1 with poor wound healing. Postoperative DSA showed that anastomotic astium was opened well in 48 patients, while PCT displayed a significant improvement in both relative cerebral blood flow [ rCBF, （ 37.79±9.76 ） mL/ （min9100 g）vs. （ 33.71±7.92） mL/（min100 g）,P 〈0.05] and the relative mean transmit time [ RMTF, （8.49± 1.97 ） s vs. （ 11.06±3.00 ） s, P 〈 0.01 ]. mRS improved significantly in both the 3 month and 12 month follow-ups（1.37±0.66 vs. 1.58±0.64, 0.84±0.57 vs. 1.51±0.67,P〈 0.05 ）. There was no ipsilateral stroke during the follow-up. Conclusion： STA-MCA bypass may im- prove the hemodynamic and neurological condition and prevent the recurrence of ischemic stroke in pa-tients combined with occlusive cerebrovascular disease and hemodynamic disturbance.

关 键 词：动脉闭塞性疾病 脑血管重建术 大脑中动脉 颞动脉 

分 类 号：R743.33[医药卫生—神经病学与精神病学]