低流量血管搭桥术治疗慢性症状性大脑中动脉闭塞疗效分析  

Clinical analysis of low flow bypass in the treatment of chronic symptomatic middle cerebral artery occlusion

作　　者：孙杨 王本琳 李琪 佟小光[3] SUN Yang;WANG Ben-lin;LI Qi;TONG Xiao-guang(Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University,Tianjin 300070,China;School of Medicine,Nankai University,Tianjin 300071,China;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津医科大学神经内外科及神经康复临床医学院,300070 [2]南开大学医学院,天津300071 [3]天津市环湖医院神经外科,天津300350

出　　处：《中国现代神经疾病杂志》2021年第7期547-552,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：天津市科技计划项目(项目编号:18ZXDBSY00180)。

摘　　要：目的探讨低流量血管搭桥术治疗慢性症状性大脑中动脉闭塞的有效性和安全性。方法纳入2016年1月至2019年12月在天津市环湖医院治疗的共28例慢性症状性大脑中动脉闭塞患者,均采用颞浅动脉⁃大脑中动脉(STA⁃MCA)搭桥术,术后采用改良Rankin量表(mRS)评估患者神经功能预后,复查DSA或CTA评估桥血管通畅情况,并复查PWI评估脑灌注改善情况。结果本研究28例患者均顺利完成STA⁃MCA搭桥术,手术成功率为100%,桥血管通畅率达100%。术后12个月患者神经功能较术前改善并且差异具有统计学意义(mRS评分1.43±0.57对2.14±0.36;t=6.301,P=0.000),患侧脑血流量和脑血容量较术前明显增加、平均通过时间和达峰时间明显降低。术后平均随访(39.41±9.39)个月,无新发脑缺血事件,桥血管通畅。结论低流量血管搭桥术治疗慢性症状性大脑中动脉闭塞安全、有效。Objective To investigate the efficacy and safety of low flow bypass in the treatment of chronic symptomatic middle cerebral artery occlusion(MCAO).Methods A total of 28 patients with chronic symptomatic MCAO who were treated in Tianjin Huanhu Hospital from January 2016 to December 2019 underwent superficial temporal artery⁃middle cerebral artery(STA⁃MCA)bypass,and the prognosis of neurological function was assessed by modified Rankin Scale(mRS).DSA or CTA were reexamined to evaluate the patency of the anastomotic site of the bridging vessels,and PWI was reexamined to evaluate improvement of cerebral perfusion.Results All 28 patients underwent STA⁃MCA bypass successfully,the success rate of operation was 100%,and the patency rate of bridge vessels was 100%.The postoperative neurological function was improved compared with that before operation,and the difference was statistically significant(mRS score 1.43±0.57 vs.2.14±0.36;t=6.301,P=0.000).Twelve months after operation,the cerebral blood flow(CBF)and cerebral blood volume(CBV)of the affected side were significantly increased,and the mean transit time(MTT)and time to peak(TTP)were significantly decreased compared with those before operation.The mean postoperative follow⁃up was(39.41±9.39)months.No new ischemic events occurred,and the bridge vessels were patchy.Conclusions Low flow bypass is safe and effective in the treatment of chronic symptomatic MCAO.

关 键 词：动脉闭塞性疾病 大脑中动脉 脑血管重建术 颞动脉 脑血管造影术 

分 类 号：R651.12[医药卫生—外科学]