摘要
目的 观察联合血管重建术治疗烟雾病患者术后侧支循环的建立情况及重建类型.方法 回顾性纳入2010年1月至2015年1月在南京医科大学附属脑科医院神经外科行直接血管重建术（颞浅动脉-大脑中动脉吻合术,STA-MCA）联合间接血管重建（脑-硬脑膜-颞肌融合术,EDMS）的烟雾病患者,共57例（手术治疗67侧大脑半球）.采用头颅CT或MR灌注成像评估脑血流情况;根据数字减影血管造影（DSA）影像,评估术后侧支循环的建立情况（大脑半球的供血范围）,并比较2种术式术后的血管重建供血范围.结果 术后随访6～60个月,平均（23±12）个月.术后6个月,67侧大脑半球中,60侧（89.6％）术侧脑血流灌注增加,65侧（97.0％）直接血管吻合通畅;DSA检查显示,新生血管供血范围≥1/3大脑中动脉（MCA）供血区域者占97.0％（65侧）,其中＞2/3区域者占82.1％（55侧）;仅2侧新生血管稀疏,供血范围＜1/3 MCA供血区域.术后6个月,19侧（28.4％）直接血管重建供血范围大于间接血管重建供血范围,23侧（34.3％）小于间接血管重建供血范围,25侧（37.3％）与间接血管重建范围相等.术后6个月,缺血与出血性烟雾病患者侧支循环的建立情况差异无统计学意义（P＞0.05）.结论 直接血管重建术联合间接血管重建术治疗烟雾病的血管重建效果较好,直接血管重建术能立刻改善缺血区的脑灌注,而间接血管重建术能提供更持久的血管重建效果.
Objective To observe the establishment of postoperative collateral circulation and its types after the combined revascularization for the treatment of patients with moyamoya disease.Methods From January 2010 to January 2015,57 patients with moyamoya disease （67 hemispheres） treated with direct vascular reconstruction （superficial temporal artery-middle cerebral artery anastomosis,STA-MCA） combined with indirect vascular reconstruction （encephalo-duro-myo-synangiosis,EDMS） at the Department of Neurosurgery,Brain Hospital Affiliated to Nanjing Medical University were analyzed retrospectively.Head CT or MR perfusion imaging was use to evaluate cerebral blood flow.According to the digital subtraction angiography （DSA） images,the establishment of collateral circulation after procedure （the cerebral hemisphere blood supply range） was evaluated.The blood supply range of revascularization of 2 surgical methods after procedure was compared.Results The postoperative follow-up was 6-60 months （mean,23 ± 12 months）.At 6 months after procedure,60 （89.6%） of 67 hemispheres showed increased cerebral blood flow perfusion on the operated sides.The direct vascular anastomosis was patent in 65 sides （97.0%）.DSA showed that the feeding range of neovascularization in patients ≥ 1/3 of the middle cerebral artery （MCA） blood supply region accounted for 97.0% （65 sides）,among them,in patients 〉2/3 blood supply region accounted for 82.1% （55 sides）.The neovascularization was sparse only in 2 sides,and the blood supply range 〈 1/3 MCA blood supply region.At 6 months after procedure,the direct revascularization blood supply range in 19 sides （28.4%） was 〉 the indirect one;and 23 sides （34.3%） were 〈 the indirect revascularization blood supply range;and 25 sides （37.3%） were equal to the indirect revascularization blood supply range.At 6 months after procedure,there was no significant difference in the establishment of collateral circulation between the patients with ischemic and hemorrhagic moyamoya disease.Conclusions The effect of the direct revascularization combined with the indirect revascularization for the treatment of revascularization of moyamoya disease is better.The direct revascularization may immediately improve the cerebral perfusion in ischemic area,while the indirect revascularization may provide a more lasting effect of revascularization.
出处
《中华神经外科杂志》
CSCD
北大核心
2016年第10期1011-1016,共6页
Chinese Journal of Neurosurgery
关键词
烟雾病
脑血管重建术
侧支循环
Moyamoya disease
Cerebral revascularization
Collateral circulation
