颅内外搭桥术对症状性慢性闭塞性脑血管病的疗效研究  

Therapeutic effect of extra-intracranial bypass surgery for symptomatic chronic occlusive ischemic cerebrovascular diseases

作　　者：于在涛 周忠清[1] 杨扬[1] 刘方军[1] 钱海[1] 孙玉明[1] 石祥恩[1] Yu Zaitao;Zhou Zhongqing;Yang Yang;Liu Fangjun;Qian Hai;Sun Yuming;Shi Xiang'en(Department of Neurosurgery,Sanbo Brain Hospital of Capital Medical University,Beijing 100093,China)

机构地区：[1]首都医科大学附属三博脑科医院神经外科,北京100093

出　　处：《中国微侵袭神经外科杂志》2021年第9期412-416,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的评估症状性颈内动脉或大脑中动脉慢性闭塞病人经颌内动脉搭桥治疗后的血流动力学改变和长期临床效果。方法回顾性研究25例症状性颈内动脉或大脑中动脉慢性闭塞病人的临床资料,均行颌内动脉-桡动脉-大脑中动脉搭桥治疗。采用超声测量术中血流量,MRI灌注(perfusion weighted imaging,PWI)或CT灌注(CTperfusion,CTP)评估局部脑血流量(regional cerebral blood flow,rCBF)、局部脑血容量(regional cerebral blood volume,rCBV)、平均通过时间(meantransit time,MTT)和达峰时间(timetopeak,TTP)。结果术中搭桥血管血流量为(81.36±30.41)ml/min。术后3 d CTA证实搭桥血管通畅率100%。术后血流动力学指标rCBF改善13例,rCBV改善7例,MTT改善18例,TTP改善22例。术后病人症状改善16例,无明显变化9例。随访3个月搭桥血管通畅率96%,6个月时通畅率84%。术后2年死亡2例。20例随访满5年,均无新发神经功能缺失。结论对症状性颈内动脉或大脑中动脉慢性闭塞病人,颌内动脉搭桥可改善其血流动力学,是治疗上的一种有效选择。Objective To evaluatethe cerebral hemodynamics changes and long follow-up results for chronic symptomatic occlusion of internal carotid artery(ICA)or middle cerebral artery(MCA)after internal maxillary artery(IMA)bypass surgery.Methods Clinical data of 25 patients with symptomatic ICA or MCA occlusion undergoing bypass surgery of IMA-radial artery(RA)-MCA were analyzed retrospectively.The blood flow was measured by intraoperative ultrasonography.The hemodynamic parameters such as regional cerebral blood flow(rCBF),regional cerebral blood volume(rCBV),mean transit time(MTT)and time to peak(TTP)were detected by perfusion weighted imaging(PWI)or CT perfusion(CTP).Results The blood flow of graft vessels was 81.36±30.41ml/min.The patency rate of graft vessels was 100%3 d after the operation.The rCBF,rCBV,MTT and TTP were improved in 13,7,18 and 22 patients respectively after operation.Postoperative symptoms improved in 16 patients and no significant change in 9.The patency rate of graft vessels was 96%in 3-months follow-up and 84%at 6-months follow-up.Two patients died 2 years after the operation.Twenty patients were followed up for 5 years,no new neurological deficit was observed.Conclusion IMA bypass surgery can improve hemodynamics for patients with chronic symptomatic occlusion of ICA or MCA,and is an effective choice in the treatment.

关 键 词：脑血管病 缺血性 慢性 搭桥术 颌内动脉 脑血流动力学 长期随访 

分 类 号：R651.12[医药卫生—外科学]