颅内外血管重建治疗烟雾病的临床研究

Clinical study of extracranial-intracranial revascularization for Moyamoya disease

目的探讨颅内血管重建治疗烟雾病的临床疗效。方法回顾性分析72例烟雾病病人的临床资料,共施行99次手术,其中直接搭桥66次,直接搭桥联合颞肌贴敷8次,单纯颞肌贴敷11次,单纯颞浅动脉贴敷14次。结果术后灌注区域出血4例,短暂性脑缺血或灌注区域局灶性梗死12例,过度灌注2例,皮肤坏死1例。术后1周内颅脑CTA显示吻合血管全部通畅。术后6个月复查SPECT或PWI脑灌注结果均不同程度改善。72例病人随访1~95个月,随访期间无搭桥侧新发梗死,脑干梗死1例,2例出血型烟雾病病人术后1年死于再出血。结论颅内血管重建术为治疗烟雾病的可靠方法 ,应积极治疗甲亢、动脉瘤等合并症。

Objective To explore the clinical outcome of extracranial-intracranial revascularization for Moyamoya disease. Methods Clinical data of 72 patients with Moyamoya disease were analyzed retrospectively. There were 99 times of surgery in total, including 66 times of direct bypass, 8 times of direct bypass combined with temporal muscle sticking, 11 times of simple temporal muscle sticking and 14 times of simple temporal artery sticking. Results The infusion region hemorrhage occurred in 4 patients, transient cerebral ischemia or focal cerebral infarction in the infusion region in 12, hyperperfusion in 2 and skin necrosis in 1. Anastomotic patency was confirmed in all patients by CT angiography within 1 week. The SPECT or PWI showed cerebral perfusion results were improved to different degrees 6 months after surgery. All the patients were followed up for 1 to 95 months, and no new cerebral infarction was found in the bypass side during the follow-up period. Two patients with hemorrhagic Moyamoya died of rebleeding 1 year after surgery. Conclusions Extracranial-intracranial revascularization is an effective method for Moyamoya disease. The accompanying diseases as hyperthyroidism, aneurysms etc. should be treated actively.