颅内外血管重建治疗老年动脉粥样硬化型缺血性脑血管病  

Extra-intracranial revascularization for atherosclerotic ischemic cerebrovascular disease in elderly patients

作　　者：温玉星[1] 顾宇翔[2] 黄绍崧[1] 辛惠宁[1] 程琼[1] 林伟[1] 倪伟[2] 

机构地区：[1]福建省立医院神经外科,福建福州350001 [2]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》2016年第1期54-57,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：福建省科技计划项目资助项目(2012Y0015)

摘　　要：目的探讨联合直接间接血运重建技术治疗老年动脉粥样硬化型缺血性脑血管病的疗效。方法 14例老年动脉粥样硬化型脑缺血患者,均接受颞浅动脉-大脑中动脉分支(superficial temporal artery-middle cerebral artery,STA-MCA)吻合与脑-硬膜-肌肉血管融合术(encephalo-duro-myo synangiosis,EDMS)相结合的手术治疗,术后美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及Barthel生活指数(Barthel Index,BI)评估临床预后,并使用CT血管造影(CT angiogram,CTA)、CT灌注成像(CT Perfusion,CTP)及全脑血管造影(digital subtractional angiogram,DSA)评价影像学效果。结果 14例患者所有吻合口经术中超声多普勒及吲哚菁绿造影证实全部通畅,患者出院时NIHSS及Barthel指数与入院时无显著差异,但术后3个月、6个月、12个月及24个月均较入院时改善。术后一周进行CTA检查提示吻合口通畅率为100%。术后6个月的DSA影像学结果提示,所有患者术侧均由颈外动脉系统向颅内代偿。14(93.3%)个直接血管吻合的吻合口保持通畅,1例吻合口不通畅患者由脑膜中动脉及颞深动脉系统代偿良好,患者出院时术侧平均通过时间(mean transit time,MTT)延长与入院时无显著差异,但术后6个月、12个月与入院时均有显著差异。结论联合直接间接血运重建治疗老年动脉粥样硬化型缺血性脑血管病效果良好。Objective The efficacy of combined direct and indirect revascularization for the atherosclerotic ischemic cerebrovascular disease in elderly patients was investigated. Methods Fourteen elderly patients with atherosclerotic cerebral ischemia underwent superficial temporal artery-middle cerebral artery （STA-MCA） combined with the encephalo-duro-myo synangiosis （EDMS）. Clinical outcomes were assessed by National Institute of Health Stroke Scale （NIHSS） and Barthel index （BI）. Radiologie outcomes were evaluated by CT angiogram （CTA）, CT perfusion （CTP） and digital subtracfional angiogram （DSA）. Results All anastomosis of 14 patients were confirmed patent by intra-operative Doppler ultrasotmd and indocyanine green. There was no significant difference in NIHSS and BI between discharge and admission. However, there was a significant difference in NIHSS and BI at 3 months, 6 months, 12 months and 24 months compared with admission. CTA showed anastomotic 100% patency rate at 1 w. DSA at 6 months suggested extra-cranial to intra-cranial compensation in all patients. Fourteen （93. 3% ） direct anastomotic storms remained patent except one stoma in one patient with good compensation from the middle meningeal artery and the deep temporal artery. There was no significant difference in mean transit time （MTT） prolongation in operated side between discharge and admission. However, there was a significant difference at 6 months and 12 months compared with admission. Conclusion The combined direct and indirect revascularization shows good efficacy for atherosclerotic ischemic cerebrovascular disease in elderly patients.

关 键 词：脑血管重建 老年 动脉粥样硬化 脑缺血 

分 类 号：R651[医药卫生—外科学]