STA-MCA+EDMS术和EDAMS术治疗烟雾病患者的效果对比及安全性分析  

Comparison of the efficacy and safety of STA-MCA+EDMS and EDAMS in treatment of patients with moyamoya disease

作　　者：李海龙[1] 魏剑波[1] 李密[1] 李冬华[1] Li Hailong;Wei Jianbo;Li Mi;Li Donghua(Department of Neurology,Panzhihua Central Hospital,Panzhihua 617000,China)

机构地区：[1]四川省攀枝花市中心医院神经外科,攀枝花617000

出　　处：《广西医科大学学报》2020年第3期510-514,共5页Journal of Guangxi Medical University

摘　　要：目的:观察颞浅动脉-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)治疗烟雾病(MMD)患者的效果,并分析两种术式的安全性。方法:回顾性分析四川省攀枝花市中心医院行外科血管重建术治疗的124例MMD患者的临床资料,其中68例行STA-MCA+EDMS术治疗(观察组),56例行EDAMS术治疗(对照组)。比较两组术前及术后2周脑血流状态[大脑前动脉脑血流量(CBF)、达峰时间(TTP)]差异,并记录两组术后12周血管重建效果、脑代谢改善情况、预后不良状况[改良Rankin量表(mRS)]和并发症发生情况。结果:术后2周,两组大脑前动脉CBF均较术前高,且观察组CBF高于对照组(P<0.05);TTP则较术前短,且观察组TTP短于对照组(P<0.05)。术后12周时,观察组血管重建效果及脑代谢改善情况明显优于对照组,且预后不良状况评分(mRS)低于对照组(P<0.05)。两组并发症发生情况无明显差异(P>0.05)。结论:STA-MCA+EDMS术及EDAMS术均对MMD患者治疗有利,且并发症均较少,但STA-MCA+EDMS术在缓解脑缺血、改善脑代谢及重建血管方面效果优于EDAMS术,更利于患者术后恢复。Objective:To compare the effect of superficial temporal artery-middle cerebral artery anastomosis combining with original encephaloduromyosynangiosis(STA-MCA+EDMS)and encephalo-duro-arterio-myo-synangiosis(EDAMS)on moyamoya disease(MMD)and to analyze the safety of the two methods.Methods:Clinical data of 124 patients with MMD who received vascular reconstruction in Panzhihua Central Hospital were retrospectively analyzed,among whom 68 cases underwent STA-MCA+EDMS(observation group),and 56 cases received EDAMS(control group).The difference in cerebral blood flow status(anterior cerebral blood flow,CBF;time to progress,TTP)between the two groups were compared before and after 2 weeks of surgery.The effects of vascular reconstruction,improvement of cerebral metabolism,poor prognosis(modified Rankin acale,mRS),and complications occurred in the two groups after 12 weeks of surgery were recorded.Results:After two weeks of surgery,CBF of the anterior cerebral arteries in both groups were higher than those before surgery,and CBF in the observation group was higher than that in the control group(P<0.05);TTP in two groups were shorter than those before surgery,and TTP in the observation group was shorter than that in the control group(P<0.05).After 12 weeks of surgery,the effect of vascular reconstruction and improvement of cerebral metabolism in the observation group were significantly better than those in the control group,and mRS was lower in the observation group than that in the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Both STA-MCA+EDMS and EDAMS are beneficial to the treatment of patients with MMD,and there were few complications.STA-MCA+EDMS is superior to EDAMS in alleviating cerebral ischemia,improving brain metabolism,and rebuilding blood vessels,which is more conducive to postoperative recovery.

关 键 词：烟雾病 脑血管重建术 脑代谢 并发症 预后 

分 类 号：R743.9[医药卫生—神经病学与精神病学]