两种血管重建术对治疗成人烟雾病效果的比较  

Efficacy comparison of two vascular reconstructions on the treatment for adult Moyamoya disease

作　　者：李宏锴 徐海涛[1] 杨升[1] 张向阳[1] 黄书岚[1] LI Hongkai;XU Haitao;YANG Sheng;ZHANG Xianggang;HUANG Shulan(DeparLmenL of Neurosurgery,Renmin HospiLal of Wuhan UniversiLy,Hubei Province,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院神经外科,湖北武汉430060

出　　处：《中国医药导报》2018年第20期58-62,共5页China Medical Herald

摘　　要：目的比较颞浅动脉-大脑中动脉分支吻合术结合脑-硬脑膜-肌肉-血管融合术(STA-MCA+EDMS)和脑-硬脑膜-动脉-肌肉血管融合术(EDAMS)治疗成人烟雾病的效果。方法回顾性分析2013年4月~2017年4月武汉大学人民医院神经外科收治的73例接受血管重建手术的成人烟雾病患者的临床资料,根据治疗方案不同分为STA-MCA+EDMS组35例和EDAMS组38例。使用全脑数字减影血管造影(DSA)、头颅CT灌注成像(CTP)和m RS评分等方法来评估血管重建效果,比较两组的疗效。记录并比较两组并发症情况及随访结果。结果STA-MCA+EDMS组血管重建优于EDAMS组,差异有统计学意义(P<0.05)。STA-MCA+EDMS组CBF值:术后2周高于术前,术后3个月高于术前,术后3个月高于术后2周,差异均有统计学意义(P<0.05)。STA-MCA+EDMS组m RS评分:术前高于术后3个月,术后2周高于术后3个月,术前高于术后2周,差异均有统计学意义(P<0.05)。EDAMS组m RS评分:术前高于术后3个月,术后2周高于术后3个月,差异均有统计学意义(P<0.05);术前高于术后2个周,差异无统计学意义(P>0.05)。STA-MCA+EDMS组术后2周m RS评分较EDAMS组低,差异无统计学意义(P>0.05),STA-MCA+EDMS组术后3个月m RS评分较EDAMS组低,差异有统计学意义(P<0.05)。EDAMS组围术期并发症发生率低于STA-MCA+EDMS组,STA-MCA+EDMS组随访期间再次发病率低于EDAMS组,差异均无统计学意义(P>0.05)。结论 STA-MCA+EDMS术相较于EDAMS术短期内疗效显著,可更好地建立起侧支循环,改善患者神经症状,围术期并发症发生率和术后复发率二者无显著差异,远期疗效有待进一步观察。Objective To compare Lhe efficacy of Superficial Lemporal arLery-middle cerebral arLery anasLomosis com-bining wiLh original encephaloduromyosynangiosis(STA-MCA+EDMS)and encephalo-duro-arLerio-myo-synangiosis(EDAMS)on Lhe LreaLmenL for adulL Moyamoya disease.Methods SevenLy-Lhree clinical cases of adulL Moyamoya dis-ease LreaLed wiLh vascular reconsLrucLion in Wuhan People HospiLal from April 2013 Lo April 2017 were enrolled for reLrospecLive analysis.On Lhe basis of differenL LreaLmenLs,Lhey were divided inLo Lwo groups,STA-MCA+EDMS group wiLh 35 cases and EMDS group wiLh 38 cases.DigiLal subLracLion angiography(DSA)resulLs,compuLed Lomography per-fusion(CTP)resulLs,modified Rankin scale(mRS)scores and LreaLmenL effecacy were compared beLween Lhe Lwo groups.PosLoperaLive complicaLions and follow-up resulLs were recorded and compared.Results RevascularizaLion was beLLer in STA-MCA+EDMS group Lhan Lhe EMDS group,Lhe difference was significanL(P<0.05).Cerebral blood flow1(CBF)value in Lhe STA-MCA+EDMS group:2 weeks posL-operaLion was higher Lhan LhaL of 3 monLhs posL-operaLion;3 monLhs posL-operaLion was higher Lhan LhaL before operaLion;3 monLhs posL-operaLion was higher Lhan LhaL of 2 weeks posL-operaLion;all Lhe differences were sLaLisLically significanL(P<0.05).The mRS scores in Lhe STA-MCA+EDMS group:Lhe scores before operaLion was higher Lhan LhaL of 3 monLhs posL-operaLion;2 weeks posL-operaLion scores high-er Lhan LhaL of 3 monLhs posL-operaLion;Lhe scores before operaLion was higher Lhan LhaL of 2 weeks posL-operaLion;all Lhe differences were sLaLisLically significanL(P<0.05).The mRS scores in Lhe EDAMS group:Lhe scores before opera-Lion was higher Lhan LhaL of 3 monLhs posL-operaLion;2 weeks posL-operaLion scores higher Lhan LhaL of 3 monLhs posL-operaLion;Lhe differences were significanL(P<0.05).The scores before operaLion was higher Lhan LhaL of 2 weeks posL-operaLion,and Lhe difference had no significance(P>0.05).The mRS scores of 2 weeks posL-operaLion in Lhe STA-MCA+EDMS group was lower Lhan LhaL of

关 键 词：烟雾病 颞浅动脉-大脑中动脉吻合术 脑-硬脑膜-动脉-肌肉血管融合术 联合手术 

分 类 号：R6[医药卫生—外科学]