合并颅内动脉瘤的烟雾病：临床特征、出血危险因素和治疗转归  

Moyamoya disease associated w ith intracranial aneurysm：clinical features, risk factors of hemorrhage and treatment outcomes

作　　者：杨怀滔[1] 张正善 段炼[1] 

机构地区：[1]安徽医科大学解放军第三0七临床学院神经外科,合肥230032 [2]解放军第三0七医院神经外科,北京100071

出　　处：《国际脑血管病杂志》2015年第2期102-106,共5页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金（81171083）;首都医学发展科研基金重点项目（2007-2028）;军事医学科学院转化医学基金（2013ZHYX008）

摘　　要：目的：探讨合并颅内动脉瘤的烟雾病患者的临床特征、出血危险因素和治疗转归。方法对合并动脉瘤的烟雾病患者的临床症状、动脉瘤位置和大小、治疗情况以及长期随访结果进行回顾性分析。结果纳入34例合并动脉瘤的烟雾病患者（35个动脉瘤），其中颅内出血组22例（64.7％），非颅内出血组12例（35.3％）。在35个动脉瘤中，颅内出血组23个（主要动脉型11个，周围动脉型12个），非颅内出血组12个（主要动脉型11个，周围动脉型1个）；小型动脉瘤29个，中型动脉瘤6个（均为出血型烟雾病患者）。颅内出血组动脉瘤以周围动脉型为主，而非颅内出血组以主要动脉型为主，动脉瘤分型存在统计学差异（ P=0.013）。颅内出血组除2例未行脑硬膜颞浅动脉血管融合术（ encephalo-duro-arterio-synangiosis, EDAS ）外，其余患者以及非颅内出血组患者均行EDAS。3例周围动脉型动脉瘤造影复查时消失，1例动脉瘤行栓塞术后复发，其余动脉瘤均无变化。长期随访显示，颅内出血组有1例患者在术后1年突发脑出血死亡，其余患者均未出现缺血性或出血性卒中；21例患者的改良Rankin量表评分改善。结论不同临床表现的烟雾病患者合并的颅内动脉瘤分型存在差异。烟雾病患者合并的颅内动脉瘤多为小型动脉瘤，可暂不直接处理，而直接行ED AS。术后颅内动脉瘤可长期稳定，部分周围型动脉瘤可消失。ObjectiveToinvestigatetheclinicalfeatures,riskfactorsforbleedingandtreatment outcomes in moyamoya disease patients w ith intracranial aneurysms. Methods The clinical symptoms, location and size of aneurysm, treatment and the long-term folow-up results of the moyamoya disease patients w ith intracranial aneurysms w ere analyzed retrospectively. Results A total of 34 moyamoya disease patients w ith intracranial aneurysms （35 aneurysms） w ere enrol ed, including 22 （64.7%） in the intracranial hemorrhage group and 12 （ 35.3%） in the non-intracranial hemorrhage group. Of the 35 intracranial aneurysms, 23 （main artery type 11, peripheral artery type 12） w ere in the intracranial hemorrhage group and 12 （main artery type 11, peripheral artery type 1） w ere in the non-intracranial hemorrhage group. There w ere 29 smal aneurysms and 6 medium aneurysms （al w ere patients w ith hemorrhagic moyamoya disease）. The aneurysms w ere mainly peripheral arterial type in the intracranial hemorrhage group, and the aneurysms w ere mainly artery type in the non-intracranial hemorrhage group. There w as significant difference in aneurysm typing betw een the tw o groups （ P= 0.013 ）. Tw o patients did not perform encephalo-duro-arterio-synangiosis （EDAS） in the intracranial hemorrhage group, other patients and those of the non-intracranial hemorrhage group performed EDAS. Angiographical reexamination revealed that 3 patients w ith peripheral aneurysm disappeared, and 1 aneurysm recurred after aneurysm embolization, and the remaining aneurysms＆amp;nbsp;did not have any change. Long-term fol ow-up show ed that 1 patient died of sudden cerebral hemorrhage at 1 year after procedure in the intracranial hemorrhage group, and the others did not have ischemic or hemorrhagic stroke. The modified Rankin scale scores w ere improved in 21 patients. Conclusions There are differences in moyamoya disease patients w ith intracranial aneurysm typing w ith different clinical manifestations. Moyamoya disease patients w ith

关 键 词：烟雾病 颅内动脉瘤 脑出血 吻合术 外科 治疗结果 

分 类 号：R651.12[医药卫生—外科学]