STA-MCA+EDMS和EDAMS血管融合术治疗烟雾病的疗效比较研究  

Efficacy of superficial temporal artery-middle cerebral artery branch anastomosis combined with encepho-duro-myo-synangiosis versus encephalo-duro-arterio-myo-synangiosis in the treatment of patients with moyamoya disease

作　　者：孙娴 王培丽 崔圆元 SUN Xian;WANG Pei-li;CUI Yuan-yuan(Department of Neurosurgery,East Hospital of Huashan Hospital Affiliated to Fudan University,Shanghai 201206,CHINA)

机构地区：[1]复旦大学附属华山医院东院神经外科,上海201206

出　　处：《海南医学》2023年第17期2493-2498,共6页Hainan Medical Journal

基　　金：上海市卫生和计划生育委员会重要薄弱学科建设项目(编号:2015ZB0301)。

摘　　要：目的比较颞浅动脉-大脑中动脉分支吻合术结合脑-硬脑膜-肌肉-血管融合术(STA-MCA+EDMS)和脑-硬脑膜-动脉-肌肉血管融合术(EDAMS)治疗烟雾病患者的临床疗效。方法选取2020年1月至2022年1月复旦大学附属华山医院东院神经外科收治的92例烟雾病患者为研究对象,按照随机数表法分为观察组(应用STA-MCA+EDMS术)和对照组(应用EDAMS术),每组46例。比较两组患者治疗后的临床疗效;于术后1 d和术后3个月,采用改良Rankin评分法评价两组患者神经功能恢复情况;分别在术前及术后3个月使用经颅多普勒超声测量脑血流量、脉压及血流峰值;于术前3 d及术后1周采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估两组患者的认知功能;比较两组患者的术后并发症情况。结果观察组患者的治疗总有效率为93.47%,明显高于对照组的76.09%,差异具有统计学意义(P<0.05);术后3个月,观察组患者的改良Rankin评分为(1.11±0.12)分,明显低于对照组的(1.67±0.26)分,差异具有统计学意义(P<0.05);术后1周,观察组患者的脑血流量、脉压、血流峰值分别为(13.54±2.33)mm/s、(35.63±15.33)mmHg、(172.59±19.35)cm/s,明显高于对照组的(11.35±1.58)mm/s、(26.34±10.55)mmHg、(150.68±18.74)cm/s,差异均有统计学意义(P<0.05);术后1周,观察组患者的MMSE得分、MoCA得分分别为(27.49±0.12)分、(27.98±0.41)分,明显高于对照组的(25.68±0.11)分、(25.68±0.11)分,差异均有统计学意义(P<0.05);观察组患者术后心律失常、肾功能衰竭、术后感染的发生率分别为6.52%、4.34%、6.52%,明显低于对照组的21.74%、17.39%、23.91%,差异均有统计学意义(P<0.05)。结论STA-MCA+EDMS治疗烟雾病能够增加患者脑血流量、脉压以及血流峰值,改善患者的神经功能和认知功能,减少术后并发症,临床应用效果较好。Objective To compare the clinical efficacy of superficial temporal artery-middle cerebral artery branch anastomosis combined with encepho-duro-myo-synangiosis(STA-MCA+EDMS)and encephalo-duro-arte rio-myo-synangiosis(EDAMS)in the treatment of patients with moyamoya disease.Methods Ninety-two patients with moyamoya disease admitted to the Department of Neurosurgery,East Hospital of Huashan Hospital Affiliated to Fudan University from January 2020 to January 2022 were selected as the research objects.They were randomly divided into an observation group(using STA-MCA+EDMS)and a control group(using EDAMS),with 46 patients in each group.The clinical efficacy of the two groups after treatment was compared.At 1 day and 3 months after operation,the neurological function recovery of the two groups was evaluated by modified Rankin score.Transcranial Doppler ultrasound was used to measure cerebral blood flow,pulse pressure,and peak blood flow before and 3 months after surgery.Mini-mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)were used to evaluate the cognitive function of the two groups at 3 days before operation and 1 week after operation.The postoperative complications were compared between the two groups.Results The total effective rate in the observation group was 93.47%,which was significantly higher than 76.09% in the control group(P<0.05).Three months after surgery,the modified Rankin score in the observation group was(1.11±0.12)points,which was significantly lower than(1.67±0.26)points in the control group(P<0.05).One week after surgery,the cerebral blood flow,pulse pressure,and peak blood flow in the observation group were(13.54±2.33)mm/s,(35.63±15.33)mmHg,and(172.59±19.35)cm/s,respectively,which were significantly higher than(11.35±1.58)mm/s,(26.34±10.55)mmHg,(150.68±18.74)cm/s in the control group(P<0.05).One week after surgery,the MMSE score and MoCA score in the observation group were(27.49±0.12)points and(27.98±0.41)points,respectively,which were significantly higher than(25.68

关 键 词：烟雾病 颞浅动脉-大脑中动脉分支吻合术结合脑-硬脑膜-肌肉-血管融合术 脑-硬脑膜-动脉-肌肉血管融合术 神经功能 认知功能 

分 类 号：R742[医药卫生—神经病学与精神病学]