Objective To study the effect of combined direct and indirect bypass surgery on moyamoya disease in adults. Methods 42 adult patients with non - hemorrhagic moyamoya disease were recruited as study subjects. And they were divided into control group and observation group. The patients in control group were treated by encephalo - duro - arterio - synangiosis ( EDAS). And the observation group were treated with superficial temporal artery - middle cerebral artery anastomosis combined with encephalo-duromyosynangiosis (STA - MCA + EDMS) . Then the focal cerebral perfusion and modified Rankin scale (mRS) before and after the treatment of two groups and the presentations of digital subtraction angiography ( DSA) and complications after the treatment of two groups were analyzed and compared. Results The focal cerebral perfusion, mRS and presentations of DSA in observation group were better than those in control group, with significant differences (P <0.05). There were no complications after the treatment in the observation group. Conclusions The effect of the superficial temporal artery - middle cerebral artery anastomosis combining with en-cephaloduromyosynangiosis on non - hemorrhagic moyamoya disease in adults is better and it can significantly improve focal cerebral perfusion.%目的 观察颅内外血管搭桥结合间接血运重建术治疗成人烟雾病的疗效.方法 选取42例成人缺血型烟雾病患者为研究对象,根据手术方式将其分为对照组与观察组,对照组22例采用脑-硬脑膜-动脉贴敷术(encephalo-duro-arterio-synangiosis,EDAS)进行治疗,观察组20例采用颞浅动脉-大脑中动脉分支直接吻合术结合脑-硬脑膜-肌肉血管融合术(superficial temporal artery-middle cerebral artery anastomosis combining with encephaloduromyosynangiosis,STA-MCA+EDMS)进行治疗,将所有患者治疗前后的局部脑血流灌注指标、改良Rankin评分(modified Rankin scale,mRs)及所有患者术后数字减影血管造影(digital subtraction angiography,DSA)表现、并发症进行统计比较.结果 观察组在局部脑血流灌注、mRs评分及DSA表现均优于对照组,差异均有统计学意义(P<0.05);观察组无术后并发症发生.结论 颞浅动脉-大脑中动脉分支直接吻合术结合脑-硬脑膜-肌肉血管融合术治疗成人缺血型烟雾病的疗效较好,可显著改善局部脑灌注.
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