不同血管重建方案在烟雾病成年患者中的应用效果对比  

Comparison of Different Blood Vessel Reconstruction Programs in Adult Patients with Moyamoya Disease

作　　者：徐春华[1] 刘越[1] 肖利民[1] 曾而明[1] 李东海[1] XU Chunhua;LIU Yue;XIAO Limin;ZENG Erming;LI Donghai

机构地区：[1]南昌大学第一附属医院,江西南昌330006

出　　处：《中国医学创新》2020年第1期13-17,共5页Medical Innovation of China

基　　金：江西省教育厅科技项目(GJJ12063)。

摘　　要：目的:探讨不同血管重建方案在烟雾病成年患者中的应用效果对比。方法:回顾性分析本院收治的80例烟雾病成人患者,按照间接血管重建和直接-间接联合方式分为两组,通过DSA检测、CT灌注、mRS检测、并发症和随访,分析两组患者治疗效果和预后等指标分析。结果:间接组和联合组患者血管重建改善率分别为56.25%、87.5%,联合组较间接组血管吻合更畅通(P<0.05)。DSA检查图表示联合组烟雾病患者手术后血管吻合且全部畅通,术后3个月DSA随访发现明显的新生侧支血管。两组术后CBF指标较术前均升高,联合组术后14 d、3个月CBF指标优于间接组(P<0.05)。两组mRS症状术前及术后14 d比较差异均无统计学意义(P>0.05),术后3个月时两组比较差异有统计学意义(P<0.05)。间接组MMD患者围术期并发症的发生概率为18.75%,联合组为15.62%,两组比较差异无统计学意义(P>0.05)。联合组MMD患者随访时间3年,在15个月时出现2例(3.12%)肢体麻木患者,剩余患者均未出现缺血或出血症状,间接组MMD患者随访时间3年,出现1例(6.25%)脑积水,1例(6.25%)短暂性脑缺血,联合组随访期间的再次发病率低于间接组,但组间比较差异无统计学意义(字2=1.931,P=0.164)。结论:STA-MCA+EDMS相比较EDAMS治疗成人烟雾病疗效更佳,CFB增加血流动力明显改善,MMD患者预后增强。Objective:To investigate the effect of different vascular reconstruction programs in adult patients with moyamoya disease.Method:A retrospective analysis of 80 adult patients with moyamoya disease admitted to our hospital was divided into two groups according to indirect hemoluminescence reconstruction and direct-indirect combination.DSA detection,CT perfusion,mRS detection,bookmarking complications and follow-up At followup,the clinical efficacy,CBF,complications and other indicators of the two groups were observed.Result:The improvement rates of vascular remodeling in the indirect group and the combined group were 56.25%and 87.5%,respectively.The vascular anastomosis in the combined group was better than that in the indirect group(P<0.05).DSA examination showed that the vascular anastomoses were smooth after the operation in the combined group,and the obvious new collateral vessels were found in the follow-up of DSA 3 months after the operation.After treatment,the levels of CBF in two groups were higher than that of before treatment,the CBF index of the combined group were better than that of the indirect group after treatment 14 days and 3 months(P<0.05).The symptoms of mRS improved in both groups,they were similar before and 14 days after surgery(P>0.05),and were excellent at 3 months(P<0.05).The probability of perioperative complications was 18.75%in the indirect group and 15.62%in the combined group,the difference were no statistically significant(P>0.05).The follow-up time of MMD patients in the combined group was 3 years,at 15 months,2 cases(3.12%)of them had numbness of limbs,the rest of them had ischemic or bleeding symptoms.The follow-up time of MMD patients in the indirect group was 3 years,1 case(6.25%)had hydrocephalus,and 1 case(6.25%)had transient cerebral ischemia.The recurrence rate of MMD patients in the combined group was lower than that in the indirect group,but there was no statistical significance between the groups(X2=1.931,P=0.164).Conclusion:STA-MCA+EDMS is more effective than EDAMS in t

关 键 词：MMD 颞浅动脉- 大脑中动脉分支吻合术 脑- 硬脑膜- 肌肉血管融合术 

分 类 号：R651.12[医药卫生—外科学]