颞浅动脉-大脑中动脉分支吻合术结合脑-硬脑膜-颞肌 血管融合术治疗成年烟雾病的临床疗效及高灌注综合征

摘要

Objective To research the effect of superficial temporal artery-middle cerebral artery anastomosis and encephalo-duro-myo-synangiosis (STA-MCA+EDMS) to the patients with moyamoya disease (MMD) at early period and its factors of cerebral hyperperfusion syndrome (CHS).Methods The data of patient with MMD in Huadong hospital between Augest,2015 and Augest,2016 was studied retrospectively.Results Forty four patients with forty nine operations were included.The communications between internal carotid system and external were reconstructed.Twenty five patients improved after the operation.The score by stroke scale decreased but without statistical difference.Eighteen patients suffered from transient CHS and the dominant hemisphere with anastomosis was the independent risk (P<0.05).Conclusions The STA-MCA+EDMS could have good effect,but should be careful with CHS or underlying complications.%目的 探讨颞浅动脉-大脑中动脉分支吻合术结合脑-硬膜-颞肌血管贴敷融合术(STA-MCA+EDMS)治疗烟雾病手术早期效果及其高灌注综合征特点.方法 通过回顾性分析符合纳入标准行STA-MCA+EDMS术的烟雾病患者临床资料.对比术前术后脑血管造影术结果;统计分析术前及术后6 m神经功能状态结果;分析术后高灌注综合征特征.结果 44人,共49次STA-MCA+EDMS术纳入本次研究;该术式能确切改善脑供血,颅内外血管形成良好交通;25人表示症状改善,但脑卒中临床神经功能缺损程度评分量表分析,评分虽有所改善,而无统计学意义;术后发生高灌注综合征等不良反应有18人(40.9%),而优势半球侧手术明显增加其发生概率(P<0.05),Matsushima分型中Ⅲ~Ⅵ型潜在风险较高.结论 临床上应根据烟雾病患者不同特征,进行有效术前评估及积极预后干预.