颞浅动脉-大脑中动脉吻合术联合血管重建术治疗低皮质微血管密度老年烟雾病的效果观察  

The effect of superficial temporal artery-middle cerebral artery anastomosis combined with revascularization in elderly patients with moyamoya disease with low cortical microvascular density

作　　者：王占伟[1] 张刚中[1] 刘光辉[1] 李直营 徐文中[2] WANG Zhanwei;ZHANG Gangzhong;LIU Guanghui;LI Zhiying;XU Wenzhong(The Seventh People's Hospital of Zhengzhou,Zhengzhou 450000,China;Department of Neurosurgery,the Second Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)

机构地区：[1]郑州市第七人民医院,河南郑州450000 [2]河南科技大学第二附属医院神经外科,河南洛阳471000

出　　处：《中国实用神经疾病杂志》2019年第11期1216-1221,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的 观察颞浅动脉大脑中动脉(STA-MCA)吻合术联合血管重建术对低皮质微血管密度老年烟雾病(MMD)的效果。方法 选取郑州市第七人民医院2012-03—2016-01治疗的61例低皮质微血管密度老年MMD患者,依据治疗方案分组,对照组30例,研究组31例。对照组实施脑硬脑膜动脉血管融通术(EDAS),研究组实施EDAS与STA-MCA吻合术联合治疗。统计2组局部脑血管改善率,并对比2组手术前、术后半年颞浅动脉搏动指数(PI)、平均流速(Vm)、血管重建情况、局部脑血管灌注率及机体功能恢复情况(mRS)。结果 术前2组STAPI、Vm、局部脑血管灌注率及mRS评分差异无统计学意义(P>0.05);术后半年,与对照组相比,研究组STAPI及mRS评分均较低,STAVm、局部脑血管灌注率及改善率均较高,差异有统计学意义(P<0.05);研究组术后血管重建良好率54.84%(17/31)高于对照组30.00%(9/30),差异有统计学意义(P<0.05)。结论 STA-MCA与EDAS联合治疗低皮质微血管密度老年MMD,效果更为显著,可改善患者脑血流及脑血管灌注情况,提高血管重建良好率,且术后功能恢复良好。Objective To investigate the application effect of superficial temporal artery and middle cerebral artery(STA-MCA) anastomosis combined with revascularization in elderly patients with moyamoya disease (MMD) with low cortical microvessel density. Methods Sixty one patients with low vessel microvessel density (MMD) senile MMD treated at the Seventh People's Hospital of Zhengzhou City from March 31st to 2016st were selected and grouped according to the treatment regimen.30 patients in the control group and 31 patients in the study group.The control group underwent brain dural arterial vascular revascularization (EDAS) and the study group underwent combined treatment of EDAS and STA MCA anastomosis.The rate of local cerebrovascular improvement in the two groups was compared,and the superficial temporal artery pulse index (PI),mean flow velocity (Vm),revascularization status,local cerebral blood vessel perfusion rate,and body function recovery before and after surgery were compared between the two groups (mRS ). Results There was no significant difference in preoperative STA PI,Vm,local cerebral vascular perfusion rate and mRS score between the two groups ( P >0.05).Compared with the control group,STAPI and mRS scores were lower in the study group.STA Vm,local cerebral vascular perfusion rate and improvement rate were all higher,and the difference was statistically significant ( P <0.05);the postoperative vascular remodeling rate in the study group was 54.84%(17/31) higher than the control group 30.00%(9/ 30) The difference was statistically significant ( P <0.05). Conclusion The combination of STA MCA and EDAS in the treatment of low vessel microvessel density and senile MMD is more effective.It can improve cerebral blood flow and cerebral vascular perfusion in patients,improve the rate of good vascular reconstruction,and good postoperative functional recovery.

关 键 词：烟雾病 颞浅动脉-大脑中动脉吻合术 血管重建术 低皮质微血管密度 脑血管改善 老年 

分 类 号：R743[医药卫生—神经病学与精神病学]