摘要
目的：通过CT灌注成像来研究颞浅-大脑中动脉搭桥（STA-MCA）＋脑-硬脑膜-颞肌血管融通术（EDMS）对脑动脉闭塞性疾病患者（包括烟雾病和非烟雾病缺血性疾病患者）脑血流动力学改善,并评估手术治疗对烟雾病和非烟雾病缺血性疾病疗效的差异。方法：比较手术前与术后3个月感兴趣区域（ROI）相关参数,如：脑血容量（CBV）、脑血流量（CBF）、平均通过时间（MTT）、达峰时间（TTP）的变化。并对搭桥患者进行术后随访,记录患者术后新发出血性或缺血性卒中事件,术后3个月通过NIHSS评分评估患者神经功能。结果：和术前CT灌注结果相比,烟雾病组与非烟雾病组患者术后相对脑血流量（rCBF）均显著增加（P〈0.05）;相对平均通过时间（rMTT）均显著缩短（P〈0.05）;但两组术后相对脑血容量（rCBV）及相对达峰时间（rTTP）变化并不明显。28例搭桥患者在术后随访3月到1年均无明显脑出血或脑梗复发,也无新的神经功能恶化,NIHSS评分总分较术前下降。结论：：STA-MCA加EDMS是治疗烟雾病和非烟雾病缺血性疾病的有效方式。CT灌注是定量评估术前及术后脑灌注的有效方式。
Objective：To investigate the improvement of hemodynamics evaluated by CT perfusion imaging for patients with cerebral artery occlusive disease（including moyamoya disease and ischemic diseases of nomoyamoya disease）after superficial temporal artery（STA）to middle cerebral artery（MCA）bypass surgery as well as to evaluate the difference in curative effect between moyamoya disease and atherosclerotic disease after surgery.Methods：Parameters such as cerebral blood volume（CBV）,cerebral blood flow（CBF）,mean transit time（MTT）and time to peak（TTP）in the region of interest（ROI）were applied to evaluate the effect of the superficial temporal artery to middle cerebral artery bypass.The patients were followed up after surgery and the newly occurred hemorrhagic or ischemic stroke events were recorded.In addition,the neurological disfunction of the patients was evaluated by NIHSS score 3 months after the operation.Results：Compared with that respectively pre-operation,the relative cerebral blood flow（rCBF）post-operation was significantly increased（P〈0.05）and the relative mean transit time（rMTT）post-operation was obviously shorter（P〈0.05）.No change of relative cerebral blood volume（rCBV）and relative time to peak（rTTP）were found.The 28 patients with bypass surgery were followed up for 3 months to 1 year post operation.There were neither obvious cerebral hemorrhage or cerebral infarction recurrence nor new neurological deterioration.Total NIHSS scores were smaller 3 months post-operation than pre-operation.Conclusion：The STA-MCA bypasses surgery is an effective method for the treatment of both moyamoya disease and atherosclerotic steno-occlusions.CT perfusion is an effective method for quantitative evaluation of cerebral perfusion before and after the operation.
作者
欧阳光
徐海涛
吴立权
朱晓楠
陶祥
陈治标
黄书岚
OUYANG Guang;XU Haitao;WU Liquan;ZHU Xiaonan;TAO Xiang;CHEN Zhibiao;HUANG Shulan(Dept.of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060,Chin)
出处
《武汉大学学报（医学版）》
CAS
2018年第5期801-804,808,共5页
Medical Journal of Wuhan University
