成人出血型烟雾病合并颅内动脉瘤的诊治及预后分析  

Diagnosis,treatment and prognosis of intracranial aneurysms in adults with hemorrhagic moyamoya disease

作　　者：李舜[1] 唐晓平[1] 文军[2] 罗仁国[1] 张柳[2] 段军伟[1] 彭华[1] 赵龙[1] 

机构地区：[1]川北医学院附属医院神经外科,四川南充637000 [2]暨南大学附属第一医院神经外科,广东广州510630

出　　处：《中国临床神经外科杂志》2017年第4期213-215,共3页Chinese Journal of Clinical Neurosurgery

基　　金：四川省科技厅科研项目(2015SZ0114);四川省南充市科技局项目(14A0040)

摘　　要：目的探讨成人出血型烟雾病合并颅内动脉瘤的治疗方法。方法回顾性分析2010年7月至2015年3月收治的63例成人出血型烟雾病的临床资料,其中合并颅内动脉瘤8例。结果 63例中,蛛网膜下腔出血22例,伴发动脉瘤4例;脑室内出血35例,伴发动脉瘤4例;其他类型颅内出血6例,未发现颅内动脉瘤。8例伴发动脉瘤中,5例为主要动脉型动脉瘤,3例为外周动脉型动脉瘤;1例行开颅动脉瘤夹闭术+颞浅动脉-大脑中动脉(STA-MCA)分流术,5例行栓塞术+STA-MCA分流术,2例行保守治疗。所有病例出院后随访12~40个月,平均24个月;开颅夹闭+分流术或栓塞+分流术治疗的病人有较好疗效,无死亡及残疾,无再出血;2例保守治疗病人分别于初次发病后第11天、第20个月再出血死亡。结论对成人出血型烟雾病合并动脉瘤,可行开颅夹闭或栓塞处理动脉瘤,再行STA-MCA分流术,预后较好;若为外周动脉型动脉瘤,不能栓塞可予保守治疗,但疗效不确切,可再发颅内出血。Objective To investigate the clinical characteristics and strategies of the diagnosis and treatment of intracranial aneurysms in the adults with hemorrhagic moyamoya disease （HMMD）. Methods The clinical data of 63 patients with HMMD treated from July, 2010 to March, 2015, of whom, 8 suffered from intracranial aneurysms and 55 not, were analyzed retrospectively. Results The aneurysms located at distal to Willis circles in 3 patients and at Willis circles in 5. Of 8 patients with intracranial aneurysms, 5 were treated by endovascularly embolization combined with superficial temporal artery-middle cerebral artery （STA-MCA） bypass, 1 by clipping intracranial aneurysm combined with STA-MCA bypass, and 2 conservatively. The curative effect was good in 6 patients undergoing the surgery and endovascular embolization. Other two patients who were conservatively treated died of intracranial rebleeding respectively 11 and 60 days after the first intracranial bleeding. Conclusions The curative effects of endovascular embolization and clipping on the intracranial aneurysms are good in the adults with HMMD. The prognosis is poor in the adults with intracranial aneurysms associated with HMMD only receiving the conservative treatment.

关 键 词：娴雾病 动脉瘤 颅内出血 动脉瘤夹闭术 颞浅动脉-大脑中动脉分流术 成人 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]