成人缺血型烟雾病22例手术治疗效果

Surgical Treatment of Ischemic Moyamoya Disease in 22 Adult Patients

目的观察成人缺血型烟雾病(IMMD)的外科手术治疗效果.方法筛选2014年1月至2015年12月昆明医科大学第一附属医院收治的IMMD经手术治疗成人患者22例,其中15例行颞浅动脉硬-颞浅筋膜-脑贴敷术(E-STA-STF-S)治疗,7例行颞浅动脉-大脑中动脉搭桥术(STA-MCA)治疗.比较手术治疗前后颅脑DSA检查结果及临床症状改善状况.结果全部患者术后均随访观察3~9个月不等.15例行E-STA-STF-S患者,12例术后3个月行颅脑DSA示颈外动脉向颅内代偿供血良好,症状明显缓解,3例血供代偿不明显;7例行STA-MCA患者,1例血供代偿不明显.术后复查颅脑DSA示血供代偿有效率为81.82%,且临床症状均有所改善.结论手术治疗能有效改善成人IMMD患者的临床症状,制定个体化的手术方案是治疗成人IMMD的重要临床措施.

Objective To observe and analyze the surgical treatment of ischemic moyamoya disease(IMMD)in adult patients.Method The clinical data of22patients with surgical treatment of ischemic moyamoya disease(IMMD)from January,2014to December,2015were analyzed retrospectively,15cases with Encephalo-STA-STF-synangiosis(E-STA-STF-S)surgery and7cases with superficial temporal artery-middle cerebral artery bypass(STA-MCA)surgery.Results Follow-up was conducted3-9months after the operation.In15cases with E-STA-STF-S surgery,digital subtraction angiography(DSA)showed good compensatory blood supply of external carotid artery to brain and relieved symptoms in12patients and no obvious compensation was found in another3cases.In7cases with STA-MCA surgery,no obvious compensation was found1case.After the review of DSA,the compensatory blood supply rate was81.82%and symptoms were improved in all the cases.Conclusions Surgical treatment can effectively improve the clinical symptoms in adult patients with IMMD.To develop individualized surgical plan is an important clinical measure for IMMD treatment in adult patients.