颞浅动脉-大脑中动脉搭桥术治疗烟雾病分析  

The curative effect analysis for superficial temporal artery-middle cerebral artery bypass in the treatment of moyamoya disease

作　　者：李琛[1] 曹旭华[1] 马志昭[1] 郑俊青[1] 张皓峰[1] 胡福广[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10期602-606,共5页Journal of Brain and Nervous Diseases

基　　金：河北省卫计委重点科技研究计划(1120140146);河北省卫计委青年科技课题(20170083);河北省科技计划项目(152777165)

摘　　要：目的通过对2016年1月至2016年6月应用颞浅动脉—大脑中动脉搭桥术治疗的60例烟雾病(MMD)患者分析,探讨颞浅动脉—大脑中动脉搭桥在MMD外科治疗的效果。方法选取本院进行颞浅动脉—大脑中动脉搭桥治疗MMD患者60例,结合术前及术后头颅CT血管造影(CTA)及CT灌注成像(CTP),客观评估其预后。结果 60例患者,均在经颅多普勒(TCD)辅助下行颞浅动脉—大脑中动脉搭桥术治疗,38例术后症状消失,16例术后症状改善,1例术后遗留言语不利,5例出现并发症;(其中4例术后肢体肌力较术前下降,1例患者71岁死亡)。所有患者术后5~7d复查头颅CTA,可见颅内外搭桥血管通畅。术后3~6个月随访,4例并发症患者均较出院时有所恢复,其余55例患者症状消失,未再出现相关脑血管病事件,复查头颅CTA及CTP可见颅内外搭桥血管通畅,同侧脑组织血流供应较术前改善。结论 MMD是一种常见的颅底异常脑血管网病,可分为出血型和缺血型,其中缺血型多见,可有反复发作等特点。该病的成人患者以内科保守治疗为主,儿童患者可行硬膜翻转颞肌贴附术。随着颅内外血管搭桥术的发展,颞浅动脉-大脑中动脉搭桥术成为目前治疗MMD最常用的方法,其对于改善患者脑血流供应具有明显效果。Objective To study from the Janary 2016 to June 2016, our group had applied the thesuperficial temporal artery-middle cerebral artery （ STA-MCA ） bypass surgery in sixty cases of patients with Moyamoyadisease （ MMD ） , and also reviewed the relevant literature aim to explore the effect of surgical treatment in STA-MCA bypass. Method Sixty patients＇s data have the the STA-MCA bypass surgery was collected. The prognosis resutl was evaluated with both CT angiography （ CTA ） and CT perfusion （ CTP ） images before and after the surgery. Results All of the sixty patients had the STA-MCA bypass surgery with the transcranial Doppler （ TCD ） assistance. Thirty-eight cases had postoperative symptoms disappeared, sixteen cases had postoperative symptoms, complications occurred in 5 cases, including one cases of postoperative residual speech adverse. 4 cases of postoperative limb muscle strength decreased. In 1 cases, patients （ age 71 ） died. All the patients were examined with cranial CTA at 5-7 days after surgery. The postoperative imaging showed bypass patency. After 3-6 months of follow-up, 4 cases of complications of patients was some recover, the remaining fifty-five patients＇ symptoms disappeared, no brain vascular disease related event occurrence. CTA and CTP images showd extracranial intraeranial bypass patency, and brain blood supply was improved compared with preoperative. Conclusion MMD is a common disease of skull base abnormal cerebral vascular network, It can be divided into hemorrhagic and ischemic tow types, among all, the ischemic was rare, the adult patients with this disease usually have conservative medical treatment as he first choice, children can have dural inversion of temporalis muscle attached feasible operation, also the disease has recurrent features. With the development of extracranial artery bypass technology, the STA-MCA bypass surgery has become one of the most commonly used method for MMD treatment, which can improve the cerebral blood flow in patients with supp

关 键 词：烟雾病 颞浅动脐-大脑中动脉搭桥 经颅多普勒 CT灌注成像 CT血管造影 

分 类 号：R743.32[医药卫生—神经病学与精神病学]