直接联合间接血管重建术治疗缺血型烟雾病疗效观察

Direct revascularization combinined with indirect revascularization for treatment of ischemic-type moyamoya disease

目的观察颞浅动脉-大脑中动脉分支吻合术联合脑-硬脑膜-肌肉血管融合术在缺血型烟雾病中的治疗作用。方法回顾分析2009年3月至2011年12月在我院接受颞浅动脉-大脑中动脉分支吻合术联合脑-硬脑膜-肌肉血管融合术治疗的21例缺血型烟雾病患者的临床资料。其中5例接受同侧颞浅动脉-大脑中动脉2支血管吻合，16例接受同侧颞浅动脉-大脑中动脉单支吻合。结果21例患者术中荧光造影显示吻合口全部通畅。16例术后1周内复查了CT血管成像，5例复查全脑数字减影血管造影术，其中20例显示吻合血管通畅，1例吻合血管闭塞。21例缺血型患者中有10例患者的运动或感觉障碍等症状在术后第2天即有明显改善。1例失语患者症状消失，4例头晕，4例头痛患者症状减轻。有2例患者临床症状较术前无明显改变。结论应用直接联合间接血管重建术能明显改善缺血型烟雾病患者缺血症状。

Objective To evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery （STA-MCA） anastomosis combinined with original encephaloduromyosynangiosis in the treatment of Ischemictype moyamoya disease. Methods All 21 patients with ischemic-type moyamoya disease admitted to our hospital from March 2009 to December 2011 were reviewed. Results Fluorescence angiography showed anastomotic paten- cy in all 21 patients. One week after operation, 16 case had CT angiography, 5 cases had digital subtraction angiog- raphy. Twenty cases showed the anastomosis patency and 1 cases had anastomosis vascular occlusion. 10 cases with motor or sensory disorder and other symptoms on the second postoperative day had significant improvement. One case of aphasia was cured. Four cases of dizziness and four headache patients had improvement. Two cases with preoperative symptoms had no obvious changes. Conclusion STA-MCA anastomosis combinined with original encephalodu- romyosynangiosis seem to be effective treating ischemic-type moyamoya disease.