颞浅动脉-大脑中动脉搭桥术联合颞肌贴敷或颞浅动脉贴敷治疗烟雾病的疗效对比分析  

Comparative analysis of superficial temporal artery to middle cerebral artery bypass combined encephalo-myo-synangiosis or encephalo-duro-arterio-synangiosis in the treatment of Moyamoya disease

作　　者：曹磊[1] 何秉征 尤浩君 石志勇 张东[2] 董阳[1] 杨波[1] 李红伟[1] Cao Lei;He Bingzheng;You Haojun;Shi Zhiyong;Zhang Dong;Dong Yang;Yang Bo;Li Hongwei(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450000 [2]首都医科大学附属北京天坛医院神经外科,北京100070

出　　处：《中华神经外科杂志》2022年第2期171-176,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(2017YFA10105003)。

摘　　要：目的比较颞浅动脉-大脑中动脉搭桥术联合脑-颞肌贴敷术(STA-MCA+EMS)与颞浅动脉-大脑中动脉搭桥术联合脑-硬膜-颞浅动脉贴敷术(STA-MCA+EDAS)治疗烟雾病患者的近期疗效和并发症。方法回顾性分析2016年1月至2021年6月郑州大学第一附属医院神经外科行STA-MCA+EMS(n=75,简称EMS组)或STA-MCA+EDAS(n=176,简称EDAS组)治疗的成人烟雾病患者的临床资料。出院时评估改良Rankin量表评分(mRS)。术后3、6个月进行电话或门诊随访,评估mRS以及有无近期并发症,复查影像学检查评估搭桥血管通畅率和松岛分级。比较两组患者的基线资料、临床疗效以及并发症。结果251例患者的术中吲哚箐绿造影显示搭桥血管均通畅。术后EMS组死亡1例,EDAS组死亡2例。248例患者的随访时间[M(Q_(1),Q_(3))]为5(4,8)个月。术后首次造影显示两组各有1例患者的搭桥血管未显影,搭桥血管通畅率为99.2%(246/248)。至末次随访,248例患者中,mRS 0分210例,1分25例,2分7例,3分3例,4分2例,5分1例;松岛分级A级96例,B级115例,C级37例。两组患者的年龄、性别、基础疾病、临床类型、铃木分期、入院mRS以及手术侧别的差异均无统计学意义(均P>0.05)。两组患者出院时mRS、随访时间、搭桥血管通畅率、松岛分级以及末次随访时mRS的差异均无统计学意义(均P>0.05)。与EDAS组比较,EMS组围手术期脑梗死[分别为10.8%(8/74)和4.0%(7/174)]、脑出血[分别为8.1%(6/74)和1.1%(2/174)]、癫痫[分别为5.4%(4/74)和0.6%(1/174)]以及硬膜下积液[分别为14.9%(11/74)和5.7%(10/174)]的发生率均高(均P<0.05)。术后近期并发症方面,EMS组脑梗死的发生率高于EDAS组[分别为5.4%(4/74)和0.6%(1/174),P=0.029]。结论两种术式的搭桥血管通畅率均较高,近期疗效均较好;而STA-MCA+EDAS围手术期发生脑梗死、脑出血、癫痫、硬膜下积液以及术后近期发生脑梗死的风险更低。Objective To compare the short-term efficacy and complications of superficial temporal artery to middle cerebral artery bypass combined encephalo-myo-synangiosis(STA-MCA+EMS)and encephalo-duro-arterio-synangiosis(STA-MCA+EDAS)in the treatment of Moyamoya disease.Methods A retrospective analysis was conducted on the clinical data of adult patients with Moyamoya disease who underwent STA-MCA+EMS(n=75,EMS group)or STA-MCA+EDAS(n=176,EDAS group)in the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2021.The modified Rankin scale score(mRS)was evaluated at discharge.At 3 and 6 months after surgery,follow-up by telephone or outpatient service was conducted to assess mRS and the presence or absence of recent complications,and re-examination of imaging examinations was performed to assess the bypass vessel patency rate and Matsushima grade.We compared the baseline data,clinical efficacy and complications of the two groups of patients.Results Intraoperative indocyanine green angiography of 251 patients revealed the patency of bypass vessels.There was 1 death in the EMS group and 2 deaths in the EDAS group.The median follow-up time(quartiles)of 248 patients was 5(4,8)months.The first postoperative angiography showed that the bypass vessels of 1 patient in each group were not developed,and the bypass vessel patency rate was 99.2%(246/248).At the last follow-up,among the 248 patients,the mRS score of 0 was reported in 210 cases,1 in 25 cases,2 in 7 cases,3 in 3 cases,4 in 2 cases,and 5 in 1 case.Matsushima grade A was reported in 96 cases,grade B in 115 cases,and grade C in 37 cases.There were no statistically significant differences in age,gender,underlying disease,clinical type,Suzuki stage,mRS score at admission,or the surgical side between the two groups of patients(all P>0.05).There were no significant differences in the mRS at discharge,follow-up time,bypass patency rate,Matsushima grade,or the mRS at the last follow-up between the two groups of patients(all P>

关 键 词：脑底异常血管网病 脑血管重建术 对比研究 治疗结果 手术后并发症 

分 类 号：R651.12[医药卫生—外科学]