颅内血流重建与支架治疗大脑中动脉重度狭窄的对比研究  

Comparative study of bypass grafting and stenting for the treatment of symptomatic middle cerebral artery stenosis

作　　者：韩宗利[1] 杜艳丽[2] 万仁宽 苏海波[1] 齐辉[1] Han Zongli;Du Yanli;Wan Renkuan;Su Haibo;Qi Hui(Department of Neurosurgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China;Medical Technology and Nursing College, Shenzhen Polytechnic, Shenzhen, Guangdong 518055, China)

机构地区：[1]北京大学深圳医院神经外科,深圳518036 [2]深圳职业技术学院医护学院,518055

出　　处：《中国微侵袭神经外科杂志》2019年第9期389-393,共5页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：深圳市卫生计生系统科研项目（编号：201601005）;深圳市三名工程项目（编号：SZSM201612008)

摘　　要：目的探讨颅内外血管搭桥重建术与血管内支架成形术治疗症状性大脑中动脉重度狭窄的疗效。方法前瞻性分析28例经内科保守治疗效果不佳的大脑中动脉重度狭窄病人的临床资料,根据手术适应证并结合病人意愿进行分组,行颞浅动脉-大脑中动脉搭桥手术13例(搭桥组),大脑中动脉球囊扩张及支架成形术15例(支架组)。术后CTA或高分辨MRI判断吻合血管通畅程度,PWI或SPECT评价脑血流灌注情况;并对术后病人的临床症状及随访期间不良事件进行分析。结果搭桥组均顺利完成吻合手术,术后1周内发生吻合口急性闭塞1例,其余12例吻合口通畅,且术后灌注不同程度改善。支架组顺利完成球囊扩张并支架植入14例,单纯球囊扩张1例;术后发生支架远端血管痉挛1例,术后灌注改善14例。两组并发症发生率差异无统计学意义(P>0.05)。23例随访1.2~34.3个月,病人症状均不同程度好转,搭桥组出现TIA 3例,支架组TIA 1例。结论颅内外血管搭桥及颅内动脉支架成形术对症状性大脑中动脉狭窄均有明显治疗效果,对不适合行支架手术的病人,颅内外血管搭桥是另一种可选择的手术方式。Objective To explore the therapeutic effect of bypass grafting and stenting for the treatment of symptomatic middle cerebral artery (MCA) stenosis. Methods Clinical data of 28 patients with severe MCA stenosis undergoing ineffective medical treament were analyzed prospectively, and the patients were divided into two growps according to surgical indication and patients' will. Thirteen patients underwent bypass grafting between superficial temporal artery and MCA (bypass group), and 15 did balloon dilatation and stenting of MCA (stent group). Postoperative CTA or high-resolution MRI was used to determine the patency degree of anastomotic vessels, and cerebral blood flow perfusion was evaluated by perfusion-weighted imaging (PWI) or SPECT. Then, clinical symptoms and adverse events during follow-up were analyzed. Results The anastomotic surgery was successfully performed, acute occlusion of anastomotic stoma occurred in 1 patient within 1 week after the operation, anastomotic patency was observed in other 12 patients, and postoperative perfusion was improved in 12 patients in the bypass group. Balloon dilatation and stent implantation were successfully completed in 14 patients, only balloon dilatation in 1, distal vasospasm of stent occurred in 1, and perfusion was improved in 14 in stent group. There was no significant difference in the incidence rate of complications between the two groups (P>0.05). Twenty-three patients were followed up for 1.2 to 34.3 months, and the patients' symptoms were improved to different degrees. Transient ischaemic attacks (TIA) occurred in 3 patients in the bypass group and in 1 in the stent group. Conclusions Bypass grafting and intracranial stenting are both significantly effective for symptomatic MCA stenosis. Intracranial and extracranial vascular bypass is another alternative surgical method for patients not suitable for stenting.

关 键 词：大脑中动脉狭窄 重度 支架成形术 球囊扩张术 脑血管重建术 

分 类 号：R651.12[医药卫生—外科学]