脑-硬膜-动脉-颞肌血管融通术治疗前循环急性脑缺血效果观察  

Observation on the therapeutic efficacy of cerebral-dural-arterial-temporal muscular vascular fusion on acute cerebral ischemia of anterior circulation

作　　者：吴卫江 徐杰 马思原 房文峰 支宏 王泳 朴炫羽 赵卫祥 戈纯 黄丽丽 WU Weijiang;XU Jie;MA Siyuan;FANG Wenfeng;ZHI Hong;WANG Yong;PIAO Xuanyu;ZHAO Weixiang;GE Chun;HUANG Lili(Department of Neurosurgery,Affiliated Hospital of Jiangnan University,Jiangsu,Wuxi 214125,China;Health Development Research Center Laboratory of Jiangsu Province,Jiangsu,Nanjing 210036,China)

机构地区：[1]江南大学附属医院神经外科,江苏无锡214125 [2]江苏省卫生健康发展研究中心实验室,江苏南京210036

出　　处：《中国医药科学》2024年第16期4-8,共5页China Medicine And Pharmacy

基　　金：江苏省卫生健康发展研究中心开放课题(JSHD2021033);江苏省中医药科技发展计划项目(MS2021045)。

摘　　要：目的 对现有颅内外血管间接吻合术进行改进,与传统方法比较其疗效的优越性。方法 回顾性分析江南大学附属医院2012年1月至2020年10月收治的48例亚急性缺血性脑血管病患者的临床资料,按手术方式不同分为对照组与观察组各24例。观察组将充分剥离外膜后的颞浅动脉顶支游离端植入分离后的侧裂岛环沟上沟,将颞筋膜分离后的颞肌植入岛环沟下沟,颞筋膜贴敷于剥离蛛网膜后的脑表面,对照组为单纯颞肌贴敷。随访比较两组美国卫生研究院卒中量表(NIHSS)评分,梗死面积及CT脑灌注成像(CTP)数据。结果 观察组NHISS评分、梗死面积和CTP均优于对照组,差异有统计学意义(P <0.05)。结论 改进后血管融通术式有利于颅内外侧支吻合的建立,扩大了供受体接触面积,提升缺血脑组织血流储备,改善预后。Objective To improve the existing indirect anastomosis of intracranial and extracranial blood vessels,so as to compare the advantages of conventional methods.Methods The clinical data of a total of 48 patients with subacute ischemic cerebrovascular disease admitted to the Affiliated Hospital of Jiangnan University from January 2012 to October 2020 were retrospectively analyzed,and they were divided into the control group(n=24)and the observation group(n=24)according to different surgical methods.In the observation group,the free end of the apical branch of superficial temporal artery was implanted into the superior sulcus of lateral fissure island ring sulcus after separation,and the temporal muscle separated from the temporal fascia was implanted into the inferior sulcus of island ring sulcus,and the temporal fascia was applied to the cerebral surface after the arachnoid mater was peeled off.While in the control group,the temporal muscle was applied alone.The scores of National Institutes of Health Stroke Scale(NIHSS),infarct area and CT perfusion scan(CTP)data were followed up and compared between the two groups.Results The NHISS score,infarct area and CTP in the observation group were all superior to those in the control group,with statistically significant differences(P<0.05).Conclusion The modified vascular fusion operation is beneficial to the establishment of intracranial and extracranial collateral branches anastomosis,expanding the contact area of donor and recipient,increasing the blood flow reserve of ischemic cerebral tissue and upgrading the prognosis.

关 键 词：颅内外血管旁路术 脑缺血 间接吻合术 颞肌贴敷 

分 类 号：R743.3[医药卫生—神经病学与精神病学]