Ⅰ型头臂型大动脉炎致颅内缺血14例临床分析

Intracranial ischemia caused by type Ⅰ Takayasu's arteritis : A clinical analysis of 14 cases

目的探讨大动脉炎导致颅内缺血的血管旁路术的选择及疗效。方法回顾性分析2005—2015年首都医科大学宣武医院血管外科14例Ⅰ型头臂型大动脉炎致颅内缺血病人的临床资料。14例均采用动脉旁路术,其中单侧颈总动脉闭塞且willis环不完整行升主动脉-单侧颈内动脉搭桥5例;双侧颈总动脉闭塞且willis环完整行升主动脉-单侧颈内动脉搭桥5例;双侧颈总动脉及双侧锁骨下动脉闭塞且willis环完整行升主动脉-双侧腋动脉搭桥1例;单侧颈总动脉及双侧锁骨下动脉闭塞且willis环完整行升主动脉-双侧腋动脉搭桥3例。结果 14例病人手术成功,共搭桥18条人工血管,1例术后出现右下肺感染及胸腔积液,1例术后人工血管急性血栓形成。病人术后症状明显改善10例、好转3例、无变化1例,近期治疗有效率为92.9%(13/14),人工血管通畅率为94.4%(17/18)。随访5~115个月,1例在术后5个月突发脑出血死亡,3条血管分别在术后6、66、79个月发生单侧颈内动脉人工血管闭塞,其余13条人工血管通畅,通畅率为81.3(13/16)。结论大脑willis环完整性对Ⅰ型头臂型大动脉炎导致颅内缺血的血管旁路术的选择有一定参考价值。

Objective To explore the choice and effect of vascular bypass treatment for intracranial ischemia caused by Takayasu＇s arteritis. Methods The clinical data of 14 cases of intracranial ischemia cased by type I Takayasu＇s arteritis admitted from 2005 to 2015 in Department of Vasculary Surgery, Xuanwu Hospital,Capital University of Medical Sciences were analyzed retrospectively. All patients received vascular bypass. Five cases of unilateral carotid artery occlusion with incomplete willis ring were performed ascending aorta to uiilateral carotid artery bypass. Five cases of bilateral carotid artery occlusion with complete willis ring were performed ascending aorta to unilateral carotid artery bypass. One case of bilateral carotid artery and subclavian artery occlusion with complete willis ring was performed ascending aorta to bilateral axillary artery bypass. Three cases of unilateral carotid artery and bilateral subclavian artery occlusion with complete willis ring were performed ascending aorta to bilateral axillary artery bypass. Results Vascular bypass treatment were completed in 14 cases and 18 artificial blood vessels were used. Postoperative pulmonary infection and pleura1 effusion occured in 1 case, and thrombosis was found in artificial blood vessels in 1 case after operation. Ischemic symptoms was significantly improved in 10 cases. Three cases get better. Symptoms were not improved in 1 case. The total effective rate of group was 92.9%（13/14）, and the total patency of graft was 94.4%（17/18）. All the cases were followed up 5 to 115 months. One died of cerebral hemorrhage after 5 months. Artificial vascular occlusion occurred in 3 cases in the 6th, 66th and 79th month respectively after operation. Operation kept other blood vessels pristine and the total patency was 81.3% （13/16）. Conclusion The willis＇s circle will be reference for the operative choice ofvascular bypass treatment for intracranial ischemia caused by type I Takayasu＇s arteritis.