烟雾病68例患者综合治疗疗效分析  

Analysis of the therapeutic efficacy for 68 patients with Moyamoya disease

作　　者：梁朝辉[1] 胡福广[1] 赵林[1] 王帅[1] 马志昭[1] 李琛[1] 曹旭华[1] 田剑光[1] 张皓峰[1] 王立群[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：《脑与神经疾病杂志》2017年第2期102-107,共6页Journal of Brain and Nervous Diseases

基　　金：河北省医学科学研究重点课题(20150220)

摘　　要：目的探讨烟雾病(MMD)患者治疗模式及其疗效。方法 68例MMD患者(缺血型54例,出血型14例)分别接受颞浅动脉—大脑中动脉搭桥手术、脑膜脑动脉血管融通术及内科治疗,随访并观察治疗疗效。结果接受颞浅动脉—大脑中动脉搭桥术(STA—MCA)40例患者、2例接受脑膜脑动脉血管融通术(EDAS),合并动脉瘤的2例行夹闭术及24例接受内科治疗。24例患者在随访过程中接受STA-MCA手术6例,EDAS手术4例。20例患者术后6个月内复查脑血管造影或CTA提示桥血管通畅及CTP提示颅内脑血流灌注显著改善,随访9.3±2.7个月接受手术治疗的患者未发生责任侧脑缺血发作;3例出血性MMD接受STA-MCA手术,其中1例患者1年后搭桥侧再次脑出血。结论 STA-MCA手术能够有效提高缺血性MMD患者颅内脑血流灌注,降低脑缺血事件发生。Objective To explore the therapeutic efficacy by different treatment strategy for patients with Moyamoya disease. Method The therapeutic efficacy was analyzed in 68 patients with Moyamoya disease （ MMD ） who accepted treatmem ways. The treatment mode included STA-MCA bypass （ anastomosis between the superficial temporal artery and cortical branch of the middle cerebral artery ） , EDAS （ encephalodurogaleosynan-giosis ） and medical treatment. The treatment effect was evaluated in further followed up. Results The treatment strategy included STA-MCA bypass in 40 patients, EDAS in 2, aneurysm clipping in 2 and medical treatment in 24 ones. In medical treatment group, six patients take regular medical treatment who endured transient ischemic attack in the follow-up process and received the bypass operation. And, four patients accepted the EDAS operation. Postoperative angiography or CTA was performed to check the patency of the direct anastomosis after surgery for 20 patients in six months. Cranial computer tomography perfusion imaging （ CTP ） was rechecked too. The results showed the anastomotic vascular patency well and the cerebral blood flow increased as well as the patients ischemic symptom was relieved in the 9.3 ± 2.7 months following up. Unfortunately, one patient with hemorrhagic Moyamoya disease displayed recurrent brain hemorrhagic post STA-MCA bypass operation 1 year. Conclusion Revascularization surgery may produce satisfying improvement intracranial blood flow hemodynamic states and prevention of recurrent cerebral ischemic stroke.

关 键 词：烟雾病 颞浅动脉-大脑中动脉搭桥术 脑膜脑动脉血管融通术 抗血小板治疗 

分 类 号：R743.9[医药卫生—神经病学与精神病学]