颅内外血管旁路移植术治疗慢性缺血性脑血管病的随访研究

Extracranial-intracranial vascular bypass graft for chronic ischemic cerebrovascular disease:a follow-up study

目的探讨颅内外血管旁路移植术对慢性缺血性脑血管病患者预防卒中的作用。方法回顾性分析首都医科大学宣武医院于2000年10月—2009年10月间因慢性缺血性脑血管病行颅内外血管旁路移植术217例患者的临床资料,并随访患者术后的血管造影、临床症状等资料及氙CT检测脑血流的改善情况。结果①217例患者平均年龄(42±13)岁,其中男131例(60.4%),女86例(39.6%)。所有患者术前6个月内均存在脑缺血症状,包括短暂性脑缺血发作117例(53.9%)、可逆性神经功能缺损37例(17.1%)、完全性卒中63例(29.0%)。所有患者术前接受血流动力学评价,显示受累血管区局部脑血流量降低。②术前血管造影显示,烟雾病62例(28.6%),一侧颈动脉闭塞72例(33.2%),单侧大脑中动脉闭塞57例(26.3%),介入治疗困难的颈动脉或大脑中动脉重度狭窄患者26例(12.0%)。③术后脑血管造影显示,388个吻合口中,380个通畅,通畅率为98.0%(380/388)。围手术期9例(4.1%)患者出现颅内血肿,1例(0.5%)因颅内血肿引发脑疝死亡。④217例患者中,10例患者失访,失访率4.6%。其中172例患者平均随访时间(38±18)个月,81例患者于手术后1年临床症状完全消失。⑤共50例患者术后1个月接受氙CT定量检测脑血流,显示患侧局部脑血流量较术前明显改善(t=3.312,P<0.05)。结论通过对慢性缺血性脑血管病患者行颅内外血管旁路移植术后的中长期临床随访,显示颅内外血管旁路移植术对血流动力学性慢性缺血性脑血管病患者具有较好的疗效。

Objective To investigate the effect of extracranial-intracranial vascular bypass graft on stroke prevention in patients with chronic ischemic cerebrovascular disease. Methods The clinical data of 217 patients with chronic ischemic cerebrovascular disease whom underwent extracranial-intracranial bypass graft in Xuan Wu Hospital, the Capital Medical University from October 2000 to October 2009 were analyzed retrospectively. The angiographic data after the procedure, clinical symptoms, and xenon CT detecting the improvement of cerebral blood flow were followed-up. Results （1）The mean age of 217 patients was 42 ± 13 years （86 females [39.6% ], 131 males [60.4% ] ）. All patients had ischemic symptoms six months before the procedure, including transient ischemic attack （117,53.9% ）, reversible ische- mic neurological deficit （37,17.1% ）, and complete stroke （63,29.0%）. All patients received hemodynamic evaluation before the procedure. It showed regional cerebral blood flow reduction in the affected vascular territory. （2）Preoperative angiography showed that there were 62 patients （28.6%） with moyamoya disease, 72 （33.2%） with unilateral carotid artery occlusion, 57 （26.3 % ） with unilateral middle cerebral artery occlusion, and 26 （ 12.0% ） with carotid or middle cerebral artery severe stenosis which was difficult to be treated by intervention. （3）Of the 388 anastomoses, 380 was patent. The patency rate was 98.0%. After the procedure, 9 patients （4.1% ） patients had intracranial hematoma, 1 （0.5 % ） died of intracranial hematoma caused cerebral hernia. （4）Of the 217 patients, 10（4. 6% ） were lost to follow-up. The mean follow-up period was 38 ± 18 months in 172 patients. One year after the procedure, the clinical symptoms in 81 patients disappeared completely after the procedure. （5）A total of 50 patients performed xenon CT for quantitative measurement of brain blood flow one month after the procedure. It showed that the regional cerebral blood flow was improved more significantly than that before the procedure （ t = 3. 312, P 〈 0.05 ）. Conclusion By the medium- and long-term clinical follow-up study for patients with chronic hemodynamic ischemic cerebrovascular disease after extracranial-intracranial bypass graft, it showed that the extracranial-intracranial bypass graft has better efficacy for patients with chronic ischemic cerebrovascular disease.