改良颅内外血管搭桥术治疗缺血性脑血管病的临床研究  

Clinical research of modified extra-intracranial bypass for ischemic cerebrovascular disease

作　　者：李亚雄 樊丰势[2] 崔志强 于玲 黄亚娟[1] 李岩 张文华 王健[1] Li Yaxiong;Fan Fengshi;Cui Zhiqiang;Yu Ling;Huang Yajuan;Li Yan;Zhang Wenhua;Wang Jian(Department of Neurosurgery,the First Hospital of Hebei Medical University,Shijiazhuang,Hebei 050000,China;Department of Neurosurgery,Bethune International Peace Hospital of PLA,Shijiazhuang,Hebei 050051,China;Department of General Surgery,Affiliated Hospital of Hebei University of Engineering,Handan,Hebei 056000,China;Department of Neurosurgery,Huanghua People's Hospital,Huanghua,Hebei 061100,China)

机构地区：[1]河北医科大学第一医院神经外科,石家庄050000 [2]解放军白求恩国际和平医院,石家庄050051 [3]邯郸市河北工程大学附属医院普外科,056000 [4]黄骅市医院神经外科,061100

出　　处：《中国微侵袭神经外科杂志》2020年第9期385-388,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：河北省科技厅项目(编号:17277736D)。

摘　　要：目的探讨改良颅内外血管搭桥术治疗缺血性脑血管病的经验及效果。方法回顾性分析改良颅内外血管搭桥术治疗64例缺血性脑血管病病人的临床资料,其中行双侧血管搭桥术4例,额与顶支双支吻合3例,顶支吻合21例,额支吻合36例。采用CT灌注成像(CT perfusion,CTP)评价术后血流灌注情况,改良Rankin量表(modified Rankin scale,mRS)评估病人预后。结果术后出现硬膜下血肿2例,高灌注综合征38例。术后6周CTA显示术侧颅内外搭桥血管通畅;CTP显示:局部脑血流量(regional cerebral blood flow,CBF)较术前明显改善(P<0.001),局部血流达峰时间(regional time to peak,TTP)和局部平均通过时间(regional mean transit time,MTT)明显降低(P<0.05)。60例随访1年,CTA显示吻合口变窄2例,手术前后mRS评分经统计学分析发现:G=-0.374、P<0.001,提示:随着时间的延长,病人神经功能逐步改善。结论改良颅内外血管搭桥术可明显提高术侧脑血流量,改善脑缺血症状,是脑血流动力学障碍性脑缺血较好的手术方式。Objective To explore the experience and efficacy of modified extra-intracranial bypass for ischemic cerebrovascular disease.Methods Clinical data of 64 patients with ischemic cerebrovascular disease treated by modified extra-intracranial bypass were analyzed retrospectively,including bilateral revascularization surgery in 4 patients,anastomosis of the frontal and parietal branch in 3,anastomosis of the parietal branch in 21 and anastomosis of the frontal branch in 36.The postoperative blood perfusion was evaluated by CT perfusion(CTP),and the prognosis result was evaluated with the modified Rankin Scale(mRS)score.Results Subdural hematoma occurred in 2 patients and hyperperfusion syndrome in 38 after operation.CTA showed that the extra-intracranial vessels were unobstructed on the operative side 6 weeks after the operation.Compared with preoperation,CTP showed that the regional cerebral blood flow(CBF)was significantly improved(P<0.001),while the regional time to peak(TTP)and the regional mean transit time(MTT)were extremely decreased 6 weeks after the operation(P<0.05).Sixty patients were followed up for 1 year.CTA showed that the anastomotic stenosis occured in 2 patients.The statistical analysis of mRS scores before and after the operation showed that:G=-0.374,P<0.001,which suggests that the patient's neurological function gradually improved gradually with time passing.Conclusions The modified extra-intracranial bypass can significantly increase the cerebral blood flow of operative side and improve the brain ischemic symptoms.It is a better surgical method for cerebral hemodynamic dysfunction-related cerebral ischemia.

关 键 词：缺血性脑血管病 脑血管重建术 血流灌注 

分 类 号：R651.12[医药卫生—外科学]