颅内外血管搭桥术、脑-硬膜-动脉-颞肌贴敷术及二者联合治疗成人烟雾病的短期效果比较  

Comparison of short-term effects of intracranial and extracranial vascular bypass grafting, brain-dura-artery-temporalis muscle patching application, and their combination in the treatment of adult moyamoya disease

作　　者：刘善贤[1] 王磊[1] 张红赟[1] 郑杰[1] 邢振义[1] LIU Shan-xian;WANG Lei;ZHANG Hong-yun;ZHENG Jie;XING Zhen-yi(Department of Neurosurgery,Xinxiang Central Hospital,Xinxiang 453099,Henan,China)

机构地区：[1]新乡市中心医院神经外科,河南新乡453099

出　　处：《广东医学》2023年第11期1385-1389,共5页Guangdong Medical Journal

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20210917)。

摘　　要：目的 探讨颅内外血管搭桥术、脑-硬膜-动脉-颞肌贴敷术以及二者联合方案治疗成人烟雾病短期效果比较。方法 选取脑外科住院患者117例,依纳入标准及手术指征分为对照组(n=25)、贴敷组(n=31)、搭桥组(n=32)及联合组(n=29),对照组予以常规治疗,贴敷组予以脑-硬膜-动脉-颞肌贴敷术,搭桥组予以颅内外血管搭桥术,联合组二者联用。比较治疗前及术后(治疗后)1周患者脑部血流动力学脑血流量(CBF),脑血容量(CBV)、造影剂达峰时间(TTP)、造影剂平均通过时间(MTT)改善情况,脑氧代谢指标颈内静脉球血氧饱和度(SjvO_(2))、动脉-颈内静脉球血氧含量差(Da-jvO_(2))和脑氧摄取率(CO_(2)ER)改善情况,并对患者随访3个月,通过对比各组3个月后美国国立卫生院制定的卒中量表(NIHSS)得分评价神经功能恢复状况。结果 各手术组术前术后对比,CBF、CBV呈上升趋势,TTP、MTT呈下降趋势,且差异均有统计学意义(P<0.05),联合组结果优于贴敷组、搭桥组,差异有统计学意义(CBF:t=7.870、6.725,P<0.001;CBV:t=4.032、3.990,P<0.001;TTP:t=2.701、2.688,P<0.01;MTT:t=4.121、3.180,P<0.01);各手术组术前术后SjvO_(2)、Da-jvO_(2)、CO_(2)ER对比,差异均有统计学意义(P<0.05),联合组结果优于贴敷组、搭桥组,差异有统计学意义(SjvO_(2):t=4.927、5.143,P<0.01;Da-jvO_(2):t=3.421、3.139,P<0.01;CO_(2)ER:t=2.758、2.526,P<0.01);术后(治疗后)3个月随访NIHSS得分,各组前后对比差异有统计学意义(P<0.05),贴敷组、搭桥组与对照组对比,差异有统计学意义(t=3.027、2.998,P<0.05),联合组得分与贴敷组、搭桥组对比,差异有统计学意义(t=3.182、3.866,P<0.05)。结论 颅内外血管搭桥术联合脑-硬膜-动脉-颞肌贴敷术治疗成人烟雾病短期疗效较好,能迅速改善脑灌注及氧代谢,并能一定程度上促进脑神经功能恢复。Objective To compare the short-term effects of intracranial and extracranial vascular bypass surgery,brain-dura-artery-temporalis muscle patching surgery,and their combination in the treatment of adult moyamoya disease(MMD).Methods A total of 117 inpatients from the neurosurgery department were selected and divided into control group,patching group,bypass group,and combined group according to inclusion criteria and surgical indications.The control group received routine treatment,the patching group underwent brain-dura-artery-temporalis muscle patching surgery,the bypass group underwent intracranial and extracranial vascular bypass surgery,and the combined group received both procedures.The improvement of cerebral blood flow dynamics(CBF,CBV,TTP,MTT)and cerebral oxygen metabolism indicators(SjvO_(2),Da-jvO_(2),CO_(2)ER)were compared between pre-treatment and 1 week post-treatment,and patients were followed up for 3 months.The neurological function recovery was evaluated by comparing the NIHSS scores of each group at 3 months.Results In each surgical group,there was a statistically significant increase in CBF and CBV and a decrease in TTP and MTT before and after surgery(P<0.05).The combined group showed better results than the patching group and bypass group,with statistically significant differences(CBF:t=7.870,6.725,P<0.001;CBV:t=4.032,3.990,P<0.001;TTP:t=2.701,2.688,P<0.01;MTT:t=4.121,3.180,P<0.01).There were statistically significant differences in SjvO_(2),Da-jvO_(2),and CO_(2)ER before and after surgery in each surgical group(P<0.05).The combined group showed better results than the patching group and bypass group,with statistically significant differences(SjvO_(2):t=4.927,5.143,P<0.01;Da-jvO_(2):t=3.421,3.139,P<0.01;CO_(2)ER:t=2.758,2.526,P<0.01).The NIHSS scores at 3 months post-treatment showed statistically significant differences in each group before and after treatment(P<0.05).The patching group and bypass group had statistically significant differences compared to the control group(t=3.027,2.998,P<0.

关 键 词：颅内外血管搭桥 脑-硬膜-动脉-颞肌贴敷术 烟雾病 

分 类 号：R743.1[医药卫生—神经病学与精神病学] R615[医药卫生—临床医学]