颅内外直接、间接联合搭桥术治疗成人烟雾病25例临床分析  

Clinical analysis of combined direct and indirect extracranial-intracranial bypass in 25 adult patients with Moyamoya disease

作　　者：胡福广[1] 梁朝辉[1] 王立群[1] 李国胜[1] 刁勋 张皓峰[1] 马志昭[1] 田剑光[1] 赵林[1] 

机构地区：[1]河北医科大学第二医院神经外科,石家庄050000

出　　处：《中国神经精神疾病杂志》2016年第5期262-266,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：河北省医学科学研究重点课题计划(编号:20150220)

摘　　要：目的探讨颅内外直接、间接联合搭桥术治疗成人烟雾病的技术要点,评价其临床意义。方法回顾性分析25例成人烟雾病患者应用直接、间接联合搭桥术治疗效果,术中分别解剖游离出颞浅动脉额支、顶支,采用较粗一支行颞浅动脉—大脑中动脉M4段直接搭桥;另一支行脑硬脑膜动脉血管融通间接搭桥术。应用改良RANKIN量表(m Rs评分)和美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分评估患者手术前1天、术后1周及术后3个月的神经系统功能状态。结果 25例患者,行30侧联合搭桥术,23例术后1周内复查CT血管成像或DSA显示吻合口通畅,头部CT灌注成像显示脑血流量较术前增加,缺血症状改善。无死亡病例,患者的中位m RS评分由术前的3(1,3)分恢复到术后1周的2(1,3)分及术后3个月的1(0,3)分,差异有统计学意义(Z=15.14,P<0.01)。患者的中位NIHSS评分由术前的5(4,8)分恢复到术后1周的4(2,7)分及术后3个月的3(1,4)分,差异有统计学意义(Z=11.36,P<0.01)。1例患者术后合并对侧半球梗死,另1例合并术侧半球出血,均遗留偏瘫症状。结论颞浅动脉-大脑中动脉直接搭桥联合脑-硬脑膜-动脉血管融通间接搭桥术,可显著增加患者近期、远期脑血流量;围手术期血流动力学稳定是手术成功的关键。Objective tracranial（EC-IC） bypass in patients with adult moyamoya disease.MethodsRetrospective analysis of combined revascularization surgery in 25 adult patients with moyamoya disease. The frontal branch and parietal branch of the superficial temporal artery（STA） were dissected. Combined revascularization surgery consisted of direct（anastomosis between the superficial temporal artery and cortical branch of the middle cerebral artery） and indirect（encephalodurogaleosynan-giosis EDAS） surgeries. Clinical status was evaluated using the modified Rankin Scale and NIHSS score at 1 day before, 1 week and 3 months after surgery.ResultsThirty lateralities were successfully performed on 25 patients. Postoperative angiography or CTA and cranial computer tomography perfusion imaging（CTP） were conducted to examine the patency of the direct anastomosis and cerebral blood flow in 23 patientswithin 1 weeks after surgery. The results showed that the anastomotic vascular patency was excellent and the cerebral blood flow increased in parallel to the relief of the patients＇ s ischemic symptoms. The median m RS scores were 3（1,3） before surgery, 2（1,3） 1 week and 1（0,3） 1 month after surgery.The median m RS scores were significantly improved（Z=15.14, P〈0.01）. The median NIHSS scores was 5（4,8） preoperatively and 4（2,7） postoperation 1 week and 3（1,4） 3 months. The median NIHSS scores were also significantly improved（Z=11.36, P〈0.01）. Unfortunately, two patients had complication and left hemiparesis. One patient complicated with contralateral hemisphere infarction and the another one complicated with ipsilateral hemispheric hemorrhage after operation.ConclusionsCombined revascularization surgery may result in satisfying improvement in clinical, angiographic, and hemodynamic states and prevention of recurrent stroke. The stabilized hemodynamic is the key point in peroperative period for moyamoya patients.

关 键 词：成人缺血型烟雾病 颅内外直接搭桥 脑硬膜动脉血管融通术 

分 类 号：R651.12[医药卫生—外科学]