硬膜动脉血管融通术治疗儿童烟雾病

Curative Effects of Encephalo-duro-arterio-synangiosis on Moyamoya Disease in Children

目的探讨儿童烟雾病(MMD)的临床特征,观察脑硬膜动脉血管融通术(EDAS)对儿童MMD的治疗作用。方法对比分析我院2002年12月至2007年10月收治并接受EDAS治疗的97例儿童MMD患者手术前后临床症状、CT和/或MR、正电子发射断层摄影(PET)、DSA等检查结果,就其临床表现、手术方法及疗效评价进行分析讨论。结果本组儿童MMD占同期收治MMD患者的29.0%,男女发病率相近,51例(52.6%)以脑梗死发病。全部病例均接受EDAS治疗,72例术后临床症状消失,25例发作频率减低;术后CT和/或MR复查85例,其中83例(97.6%)手术侧未发现新发梗死;术后PET检查70例,其中58例(82.9%)脑血流状况改善;术后DSA复查22例,其中21例(95.5%)显示良好的颅内外血管吻合。结论中国儿童MMD患者似有自身的发病特征;应用EDAS术能有效的预防儿童MMD患者脑缺血发作。

Objective To explore the clinical features and curative effects of encephalo-duro-arterio-synangiosis （EDAS） on Moyamoya disease （MMD） in the children. Methods The clinical data of 97 children with MMD who underwent EDAS from December, 2002 to October, 2007 in our hospital, were analyzed retrospectively. All the patients were followed up for more than 3 months after the operation. The postoperative clinical manifestation and imaging data were compared with preoperative ones. Results Ninety-seven children with MMD accounted for 29.0% of all the patients with MDD treated during the same period in our department. There was insignificant difference in the incidence of MMD between male and female. The preoperative cerebral infarction occurred in 51 patients （52.6%）. All the preoperative symptoms disappeared in 72 cases and were relieved in 25 cases after the operation. The cerebral infarctions did net recurred in 83 of 85 patients in whom postoperative CT and/or MR examionstions were performed. The postoperative cerebral blood flow significantly increased in 58 of 70 patients （82.9%） in whom positron emissior tomography was performed. Postoperative DSA examinations revealed good revascularization in 21 of 22 patients （95.5%）. Conclusions The clinical features of MMD in Chinese children may different from the children of the other countries. The recurrence of the cerebral ischemia may be prevented by EDAS in children with MMD.