成人出血型烟雾病的临床特点及诊治探讨  

Clinical characteristics and treatment for adult hemorrhagic type moyamoya disease

作　　者：李舜[1,2] 王向宇[1,3] 李辉[1] 刘晓[1] 文朋 

机构地区：[1]广州南方医科大学珠江医院神经外科 广东神经外科研究所 广东省脑功能修复与再生重点实验室,广州5102822 [2]川北医学院附属医院神经外科,南充637000 [3]暨南大学华侨医院神经外科,广州510630

出　　处：《中国实用神经疾病杂志》2015年第4期13-14,共2页Chinese Journal of Practical Nervous Diseases

摘　　要：目的对成人出血型烟雾病的临床特点及诊治方法进行探讨。方法 47例成人出血型烟雾病患者,其中21例行颞浅动脉-大脑中动脉分支吻合术(STA-MCA),4例行脑-颞肌贴敷术(EMS),3例行脑-硬脑膜-动脉-肌肉血管融合术(EDAMS),19例予以保守治疗。结果所有患者均为急性出血性脑卒中,其中以脑室出血及脑室联合脑实质出血者居多。21例行STA-MCA吻合术患者术后随访预后良好,均未再次出血;4例行EMS术患者及3例行EDAMS术患者中各有1例发生颅内再出血;19例保守治疗患者中7例发生颅内再出血,4例死亡。结论成人出血型烟雾病为临床上较为少见的脑血管疾病,具有较高的再出血风险,早期及时采取合理的方案进行治疗,有利于改善患者预后,行颞浅动脉-大脑中动脉分支吻合术可能有利于降低颅内再出血的几率。Objective To investigate the clinical characteristics,diagnosis method and treatment strategy of adult hemorrhagic type moyamoya disease.Methods The clinical data of 47 patients with adult hemorrhagic type moyamoya disease in Zhujiang Hospital of Southern Medical University from March 2005 to January 2012 were analyzed retrospectively.21 cases of patients were performed with superficial temporal artery-to-middle cerebral artery（STA-MCA）,4cases of patientst were performed with encephalo-myo-synangiosis（EMS）,3 cases of patients were performed with encephalo-duro-arterio-myo-synangiosis（EDAMS）,19 cases of patients were treated with conservative treatment.Results All patients were acute hemorrhagic stroke,most of them were intraventricular hemorrhage.All discharged patients were followed up for 12-44 months,with an average of 26 months.21 patients with STA-MCA had a good prognosis and no intracranial hemorrhage occurrence;1 case of patient with EMS and 1 case of patient with EDAMS were occurred intracranial hemorrhage again.7 cases of patients with conservative treatment were occurred intracranial hemorrhage again and 4cases of patients died.Conclusion Adult hemorrhagic moyamoya disease is relatively rare in clinical cerebrovascular disease and reasonable treatment may improve the prognosis.STA-MCA can reduce the occurrence of intracranial hemorrhage of patients with adult hemorrhagic moyamoya disease.

关 键 词：成人 烟雾病 脑出血 颅内外血管重建术 

分 类 号：R743.4[医药卫生—神经病学与精神病学]