蛛网膜对儿童缺血型烟雾病间接颅内外血管重建术疗效的影响

Impact of arachnoid on the clinical effect of indirect revascularization in treatment of ischemic-type moyamoya disease in children

目的探讨儿童缺血型烟雾病行间接颅内外血管重建术时打开蛛网膜对术后血管重建疗效的影响。方法回顾性分析2010年8月至2015年11月21例(28侧)行间接颅内外血管重建术的儿童缺血型烟雾病患者临床资料,术中打开蛛网膜组12例(18侧),术中未打开蛛网膜组9例(10侧);术后12个月时复查MRI和DSA以及结合临床症状来评价打开蛛网膜与未打开蛛网膜组颅内外血管重建术后疗效。结果两组术后均有不同程度侧支循环形成及PWI改善,术中打开组术后12月时DSA侧支循环的良好及一般率达94.44%明显优于未打开组的60%,且构成的差异有统计学意义(P<0.05);两组术后临床症状改善差异无统计学意义,而术中打开蛛网膜组的优秀及良好率达88.89%,高于未打开组的60%;两组并发症差异无统计学意义。结论术中打开蛛网膜较未打开者可能更有利于改善儿童缺血型烟雾病间接颅内外血管重建术的疗效。

Objective To investigate the impact of arachnoid cut open during indirect revascularization on the clinical effect of revascularization in children with ischemic-type moyamoya disease. Methods A retrospective analysis was performed for the clinical data of21 children（28 sides） with ischemic-type moyamoya disease who underwent indirect revascularization from August 2010 to November2015; 12 children（18 sides） were enrolled in opened arachnoid group and 9（10 sides） were enrolled in unopened arachnoid group.Magnetic resonance imaging and digital subtraction angiography（ DSA） were performed at 12 months after surgery to evaluate the clinical effect of revascularization in the two groups,with reference to clinical symptoms. Results Both groups had formation of collateral circulation and improvement in perfusion-weighted imaging,and at 12 months after surgery,the opened arachnoid group had a significantly higher good and general rate than the unopened arachnoid group（94. 44% vs 60%,P〈0. 05）. There was no significant difference in the improvement of clinical symptoms after surgery between the two groups,and the opened arachnoid group had a higher excellent and good rate than the unopened arachnoid group（88. 89% vs 60%,P〈0. 05）. There were no significant differences in complications between the two groups. Conclusions Cutting the arachnoid open during surgery may improve the effect of indirect revascularization in children with ischemic-type moyamoya disease.