直接血运重建术联合颅骨多点钻孔治疗儿童缺血型烟雾病

Treatment of pediatric ischemia moyamoya disease by direct bypass combined with multiple burr hole

目的探讨颞浅动脉-大脑中动脉搭桥手术联合颅骨多点钻孔术治疗缺血型儿童烟雾病（Moyamoya病）的临床效果。方法选取2010年1月至2013年10月北京天坛医院神经外科手术治疗缺血型烟雾病患儿，共31例。将31例患儿分为颞浅动脉-大脑中动脉搭桥手术（STA—MCA）联合颅骨多点钻孔（MB）手术组（n=16）和单纯STA-MCA搭桥手术组（n=15），对手术后临床症状改善情况进行比较。结果在所有患儿中，出现好转24例（77．4％），病情未见明显变化者5例（16．1％），病情恶化者2例（6．5％）。STA—MCA＋MB组较STA—MCA组术后mRS评分下降明显，差异有统计学意义（P〈0．05）。结论STA-MCA搭桥手术联合多点钻孔手术比单纯STA—MCA搭桥术更能有效的缓解儿童烟雾病的临床症状，且并发症无明显增加。

Objective To investigate the treatment outcome of superficial temporal artery-middle cerebral artery bypass （STA-MCA） combined with multiple burr hole （MB） in pediatric ischemia moyamoya disease. Method A total of 31 pediatric patients with ischemic moyamoya disease who were admitted to Beijing Tiantan hospital from 2010 to 2013 were divided into two groups which were STA-MCA ＋ MB surgery group （ n = 16 ） and STA-MCA surgery only group （ n = 15 ）. Results In all patients, the number of patients with symptom improvement was 24 （77.4%）, the number of patients with no symptom improvement was 5 （16. 1% ） and with symptom deterioration was 2 （6. 5% ）. The postoperative modified rankin scale （mRS） in STA-MCA ＋ MB group was significantly lower than that in STA-MCA group （P 〈 0. 05）. Conclusion The treatment outcome of STA-MCA combined with MB is superior to STA-MCA bypass surgery only and doesn＇t increase the incidence of complication.