脑血运重建术治疗成人脑底异常血管网病的疗效分析  

Short-term efficacy of STA-MCA bypass combined with ence-phalo-myo-synangiosis for adult moyamoya diseases:single vessel bypass vs.double-vessel bypass

作　　者：张果 秦小宏 程荆 吴明洪 张文斐[1] 吴立权[1] 陈治标[1] ZHANG Guo;QIN Xiao-hong;CHEN Jin;WU Ming-hong;ZHANG Wen-fei;WU Li-quan;CHEN Zhi-biao(Department of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院神经外科,武汉430060

出　　处：《中国临床神经外科杂志》2023年第2期65-68,共4页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(82201515);湖北省自然科学基金(2021CFB057)。

摘　　要：目的探讨颞浅动脉(STA)-大脑中动脉(MCA)分流术联合颞肌贴敷术治疗脑底异常血管网病(MMD)时单支血管分流术与双支血管分流术的疗效差异。方法2020年1月至2022年6月前瞻性收治符合标准的MMD共59例,37例应用STAMCA单支血管分流术联合颞肌贴敷术治疗(单支分流组),22例应用STA-MCA双支血管分流术联合颞肌贴敷术治疗(双支分流组)。结果术后3个月DSA或CTA显示分流血管通畅,其中分流血管显影良好38例;49例(83.1%)神经功能改善(手术前后mRS评分差值>0),47例(79.7%)脑组织血供改善(手术前后脑灌注评分差值<0);未发生手术相关并发症。两组术后3个月mRS评分及脑灌注评分均明显改善(P<0.05),而且,双支血管分流组明显优于单支血管分流组(P<0.05)。双支血管分流组术后mRS评分改善率、脑灌注评分改善率均明显高于单支血管分流组(P<0.05)。结论STA-MCA分流术联合颞肌贴敷术治疗MMD疗效良好,而且双支血管分流术的短期预后优于单支血管分流术。Objective To analyze the short-term prognosis of superficial temporal artery(STA)-middle cerebral artery(MCA)combined with ence-phalo-myo-synangiosis for patients with moyamoya disease(MMD).Methods A total of 59 patients with MMD were prospectively recruited from January 2020 to June 2022.Thirty-seven patients were treated with STA-MCA single-vessel bypass combined with ence-phalo-myo-synangiosis(single bypass group),and 22 patients were treated with STA-MCA double-vessel bypass combined with ence-phalo-myo-synangiosis(double bypass group).Results Three months after the operation,DSA or CTA showed patency in all bypass vessels.Neurological function was improved(with a difference of mRS score before and after operation>0)in 49 patients(83.1%),and brain tissue blood supply was improved(with a difference of cerebral perfusion score before and after surgery<0)in 47 patients(79.7%).There were no surgery-related complications.The mRS and cerebral perfusion scores were significantly improved in both groups 3 months after the surgery(P<0.05),and they were significantly better in the double bypass group than those in the single bypass group(P<0.05).The improvement rates of mRS score and cerebral perfusion score in the double bypass group were significantly higher than those in the single bypass group(P<0.05).Conclusions STA-MCA bypass combined with ence-phalo-myo-synangiosis is effective for treating MMD,and the short-term prognosis of double-vessel bypass is better than that of the single-vessle bypass.

关 键 词：脑底异常血管网病 烟雾病 血运重建术 颞肌贴敷术 颞浅动脉 大脑中动脉 疗效 

分 类 号：R744.1[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]