颈外动脉-桡动脉-大脑中动脉搭桥术治疗血流代偿不良的大型或巨大型颈内动脉动脉瘤的临床观察  

Clinical evaluation of high-flow bypass surgery from the external carotid artery to the middle cerebral artery via the radial artery for treating large or giant internal carotid artery aneurysms with insufficient collateral circulation

作　　者：丁茂华 王序[2] 佟小光[1] Ding Maohua;Wang Xu;Tong Xiaoguang(Department of Neurosurgery,Tianjin Huanhu Hospital,Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University,Tianjin 300350,China;Department of Neurosurgery,the People′s Hospital of Anyang City,Anyang 455000,China)

机构地区：[1]天津市环湖医院神经外科,天津医科大学神经内外科及神经康复临床学院,天津300350 [2]安阳市人民医院神经外科,安阳455000

出　　处：《中华神经外科杂志》2024年第10期1004-1010,共7页Chinese Journal of Neurosurgery

摘　　要：目的探讨颈外动脉(ECA)-桡动脉(RA)-大脑中动脉(MCA)M2段搭桥联合动脉瘤孤立术对于血流代偿不佳的大型或巨大型颈内动脉(ICA)动脉瘤患者的临床疗效。方法本研究为单中心回顾性研究,纳入2016年1月至2021年6月天津市环湖医院神经外科收治的8例采用ECA-RA-M2搭桥联合动脉瘤孤立术治疗的大型(最大径为16~25 mm)或巨大型(最大径>25 mm)ICA动脉瘤患者,共10个动脉瘤(2例为串联动脉瘤)。其中,破裂动脉瘤2例,未破裂动脉瘤6例。所有患者均通过术前评估证实球囊闭塞试验阳性和(或)磁共振灌注加权成像提示血流灌注分期为Ⅱ2期。采用O′Kelly-Marotta(OKM)分级评估术后即刻动脉瘤的闭塞程度。观察围手术期手术相关并发症。术后定期行临床和影像学随访,观察临床症状的变化情况,采用改良Rankin量表评分(mRS)和Karnofsky功能状态评分评估患者的预后。结果8例患者中,术后6例达到完全闭塞(OKM分级D1级),1例为近全闭塞(OKM C1级)。围手术期2例患者发生缺血性卒中。8例患者均获得随访,临床随访时间[M(Q_(1),Q_(3))]为69.9(55.0,85.3)个月。至末次随访,6/8的患者术前临床症状缓解或治愈,随访期间1例患者发生缺血性卒中。8例患者末次随访的mRS[M(Q_(1),Q_(3))]为0(0,1)分,其与术前mRS[1(1,1)分]的差异无统计学意义(Z=-1.19,P=0.236)。末次随访,8例患者的Karnofsky功能状态评分为(92.5±13.9)分。影像学随访时间[M(Q_(1),Q_(3))]为35.8(5.8,68.8)个月,1例患者的动脉瘤较术前缩小,其余7例患者的动脉瘤达到完全或近全闭塞。结论对于血流代偿不佳的大型或巨大型ICA动脉瘤,ECA-RA-M2搭桥联合动脉瘤孤立术的动脉瘤闭塞率高,患者的临床预后良好,安全性较理想。ObjectiveTo investigate the clinical efficacy of external carotid artery(ECA)-radial artery(RA)-middle cerebral artery(MCA)M2 segment bypass combined with aneurysm isolation surgery in patients with large/giant internal carotid artery aneurysms.MethodsThis retrospective single-center study enrolled 8 patients diagnosed with large/giant internal carotid artery aneurysms(10 cases of aneurysms in total and 2 cases of tandem aneurysms)who underwent ECA-RA-M2 bypass combined with aneurysm isolation surgery at the Department of Neurosurgery,Tianjin Huanhu Hospital between January 2016 and June 2021.Of the 8 patients,2 were ruptured aneurysms.Preoperative evaluation confirmed positivity in the balloon occlusion test(BOT)and/or stageⅡ2 brain perfusion weighted imaging(PWI).Immediate postoperative embolization degree was assessed using the O′Kelly-Marotta(OKM)grading system.Intraoperative and postoperative complications were documented.Clinical symptoms were observed and outcomes were evaluated using the modified Rankin Scale(mRS)and Karnofsky Performance Status(KPS)scale.ResultsAmong the 8 patients,the postoperative complete occlusion/OKM grading of D1 and near-total occlusion/OKM C1 was observed in 6 patients and 1 patient,respectively.During the perioperative period,2 patients experienced ischemic stroke.The follow-up duration[M(Q_(1),Q_(3))]of 8 patients was 69.9(55.0,85.3)months.By the end of the follow-up period,6/8 of patients exhibited relief or recovery from preoperative clinical symptoms.Ischemic stroke occurred in 1 patient.At the last follow-up,the mRS score was 0 in 5 patients,1 in 2,4 in 1.There was no statistically significant difference in mRS scores before and after surgery(Z=-1.19,P=0.236).The KPS scores of 8 patients were 92.5±13.9 points.Imaging follow-up time[M(Q_(1),Q_(3))]was 35.8(5.8,68.8)months,with aneurysm shrinkage demonstrated in 1 patient and complete or near-total occlusion in the remaining 7 patients.ConclusionECA-RA-M2 bypass combined with aneurysm isolation remains an essential thera

关 键 词：颅内动脉瘤 颈内动脉 脑血管重建术 治疗结果 大型或巨大型 手术并发症 

分 类 号：R651.12[医药卫生—外科学]