侧-侧吻合在烟雾病颞浅动脉-大脑中动脉搭桥术中的初步应用  

Preliminary application of side-to-side anastomosis in superficial temporal artery-middle cerebral artery bypass surgery for moyamoya disease

作　　者：章剑剑 辛灿 余金[1] 万蕾 沈艳萍 魏嵬 李翔 陈劲草[1] Zhang Jianjian;Xin Can;Yu Jin;Wan Lei;Shen Yanping;Wei Wei;Li Xiang;Chen Jincao(Department of Neurosurgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院神经外科,武汉430071

出　　处：《中华神经外科杂志》2023年第4期385-389,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81671157)。

摘　　要：目的初步探讨侧-侧吻合在成人烟雾病颞浅动脉-大脑中动脉(STA-MCA)搭桥术中应用的可行性及临床效果。方法回顾性分析2022年2—5月武汉大学中南医院神经外科收治的46例采用侧-侧吻合式STA-MCA搭桥术联合颞肌贴敷治疗成人烟雾病患者的临床资料。所有患者术前行数字减影血管造影(DSA)、头颅MRI及单光子发射计算机断层显像(SPECT)检查评估脑血流灌注情况及确认搭桥部位;术后1~2 d行头颅MRI、SPECT检查评估脑血流改善情况;行头颅磁共振血管成像(MRA)或DSA检查评估搭桥血管的通畅性;术后3个月行DSA检查并使用松岛分级评估血运重建效果;采用改良Rankin量表评分(mRS)评估患者的临床疗效。结果46例患者的手术均顺利完成,4例发生围手术期并发症,其中高灌注综合征和脑梗死的发生率分别为6.5%(3/46)和2.2%(1/46);术后1 d 46例患者的SPECT结果显示搭桥区域相对脑血流灌注与术前的比值为1.20±0.14;术后MRA或DSA随访显示搭桥血管的通畅率为97.8%(45/46)。术后3个月34例患者获得DSA随访,结果显示松岛分级A、B、C级的患者分别为16、12、6例。所有患者均获得临床随访,mRS为0分者由术前的8例增加至38例,1分者由术前的37例降至6例,2分者由术前的1例增加至2例,95.7%(44/46)的患者神经功能得到改善。结论初步结果表明,侧-侧吻合式STA-MCA搭桥术能有效治疗成人烟雾病,且围手术期并发症的发生率低。Objective To preliminarily discuss the feasibility and clinical efficacy of side-to-side anastomosis in superficial temporal artery-middle cerebral artery(STA-MCA)bypass surgery in adults with moyamoya disease(MMD).Methods A retrospective analysis was conducted on the clinical data of 46 adult patients with MMD who were treated by side-to-side anastomotic STA-MCA bypass combined with encephalo-duro-myo-synangiosis from February to May 2022 in the Department of Neurosurgery of Zhongnan Hospital of Wuhan University.All patients underwent preoperative digital subtraction angiography(DSA),MRI,and single photon emission computed tomography(SPECT)examinations to evaluate cerebral blood perfusion and confirm bypass sites.SPECT examinations at 1-2 days post operation were performed to evaluate the improvement of cerebral blood flow(CBF).Magnetic resonance angiography(MRA)or DSA examination was performed to evaluate the patency of bypass vessels.At 3 months post operation,DSA examination was performed and the outcome of revascularization was evaluated using Matsushima grading system.The modified Rankin Scale(mRS)was used to evaluate the patients′clinical outcomes.Results The operations of 46 patients were all successfully completed,and perioperative complications occurred in 4 cases,among which the incidences of hyperperfusion syndrome and cerebral infarction were 6.5%(3/46)and 2.2%(1/46)respectively.At 1 day post operation,the SPECT results of all patients showed that postoperative/preoperative relative CBF value at the bypass site was 1.20±0.14.MRA or DSA follow-up after operation showed that the patency rate of bypass vessels was 97.8%(45/46).Thirty-four patients were followed up by DSA at 3 months post operation,and the results showed that there were 16,12 and 6 patients with Matsushima grade A,B and C respectively.All patients were followed up clinically.The number of patients with mRS score of 0 increased from 8 before operation to 38,that of patients with mRS score of 1 decreased from 37 before operation to 6,th

关 键 词：脑底异常血管网病 成年人 治疗结果 脑血管重建术 侧-侧吻合 

分 类 号：R651.12[医药卫生—外科学]