摘要
目的探讨不同血管重建术治疗成人烟雾病的疗效及预后情况。方法采用前瞻性研究方法选取2015年1月至2017年12月在中国人民解放军第八五医院神经外科行血管重建术的88例成人烟雾病患者,按照随机数字表法将患者分为对照组与研究组,每组各44例。对照组患者实施脑-硬脑膜-动脉-肌肉血管融合术(EDAMS)治疗,研究组患者实施颞浅动脉-大脑中动脉分支吻合术(STA-MCA)联合脑-硬脑膜-肌肉血管融合术(EDMS)治疗。比较两组患者的临床疗效、术前与术后3个月时脑血流[颞浅动脉搏动指数(STA PI)与平均流速(STA Vm)]情况、术前与术后3个月神经功能[采用改良RANKIN量表(mRS)评分]的变化、术后并发症情况,以及随访1年内的预后情况。结果研究组治疗的优良率(95.45%)高于对照组(81.82%),差异具有统计学意义(P<0.05)。术后3个月时研究组STA PI(1.20±0.48)低于对照组(1.73±0.52),STA Vm(53.78±12.00 cm/s)高于对照组(41.68±10.20 cm/s),差异均具有统计学意义(P<0.05)。术后3个月时研究组mRS评分(1.25±0.52分)低于对照组(1.85±0.62分),差异有统计学意义(P<0.05)。研究组术后并发症发生率(4.55%)与对照组(4.55%)比较,差异无统计学意义(P>0.05)。研究组1年内不良预后的发生率(2.27%)与对照组(4.55%)比较,差异无统计学意义(P>0.05)。结论虽然EDAMS与STA-MCA联合EDMS治疗成人烟雾病的术后并发症与1年内的预后情况相当,但与单纯EDAMS相比,STA-MCA联合EDMS的短期疗效更为理想,可以有效恢复侧支循环,调节患者的神经功能,值得临床推广。
Objective To explore the efficacy and prognosis of different vascular reconstruction in treatment of adult moyamoya disease.Methods A prospective study was conducted to select 88 adult patients with moyamoya disease,they underwent neurovascular surgery in the Eighth Five-Year Hospital of the People's Liberation Army during January 2015 to December 2017.These patients were divided into control group and study group according to the random number table method,44 cases in each group.Patients in study group were treated with superficial temporal artery-middle cerebral artery branch anastomosis(STA-MCA)combined with brain-dura-muscular vascular fusion(EDMS),while patients in control group were treated with brain-dura-artery-muscle vascular fusion(EDAMS).The clinical efficacy,cerebral blood flow(STA PI and STA Vm)before and 3 months after operation,changes of neurological function before and 3 months after operation[evaluated by modified RANKIN scale(mRS)scores],complications after operation,and prognosis within 1 year after follow-up were compared between these two groups.Results The excellent and good rate of treatment in study group was 95.45%higher than that(81.82%)of control group(P<0.05).In 3 months after the operation,the STA PI(1.20±0.48)in study group were lower than those in control group(1.73±0.52)in control group,and STA Vm(53.78±12.00 cm/s)were higher than those(41.68±10.20 cm/s)of control group.The difference was statistically significant(P<0.05).The mRS scores(1.25±0.52 point)in study group were lower than those(1.85±0.62 point)in control group at 3 months after operation(P<0.05).There was no significant difference in the incidence of complications between study group and control group 4.55%(P>0.05).There was no significant difference in the incidence of adverse prognosis between study group(2.27%)and control group(4.55%)(P>0.05).Conclusion Although the complications of EDAMS and STA-MCA combined with EDMS during the treatment course of adult moyamoya disease are comparable to the prognosis in one year,the short-term effect of STA-MCA combined with EDMS is better than EDAMS,which can effectively restore collateral circulation and regulate the nerve function of patients,hence it is worthy to be applied for clinical promotion.
作者
马如钧
于明琨
张伟
刘永
汤明磊
MA Ru-jun;YU Ming-kun;ZHANG Wei(Department of Neurosurgery,Eighth Five Hospital of the Chinese People's Liberation Army,Shanghai 200052,China;Department of Neurosurgery,Shanghai Changzheng Hospital,Shanghai 200003,China)
出处
《临床和实验医学杂志》
2019年第16期1759-1762,共4页
Journal of Clinical and Experimental Medicine
基金
国家“十二五”科技支撑计划项目(编号:2011BAI08B05)
关键词
成人烟雾病
血管重建术
疗效
预后
Adult moyamoya disease
Revascularization
Efficacy
Prognosis
