脑血运重建治疗缺血性烟雾病手术时机的选择

Optimum operation time of revascularization for ischemic moyamoya disease

目的探讨脑血运重建术治疗缺血性烟雾病的最佳手术时机。方法回顾性分析武汉大学人民医院2016年7月—2018年5月收治的41例缺血性烟雾病患者的临床资料。所有患者均行颞浅-大脑中动脉搭桥+颞肌贴敷术,依据缺血性卒中发生时间与手术之间的时间间隔,将患者分为早期组(1~3个月,17例)和晚期组(>3个月,24例)。分析比较两组患者术后3个月脑灌注改善率及神经功能缺损恢复状况;以及术后并发症(脑出血、脑梗死、过度灌注)的发生率。结果与晚期组相比,早期组患者术后3个月的脑灌注改善率更高,美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分明显降低,差异均有统计学意义(P<0.001,P=0.01)。术后总的并发症(包括过度灌注、脑出血、脑梗死)发生率,早期组为52.9%,晚期组为54.2%,两组的差异无统计学意义(P>0.05)。结论 缺血性烟雾病患者卒中事件后1~3个月内行脑血运重建术,对于改善患者脑灌注和神经功能恢复更有效,并且不增加术后并发症发生的风险。

Objective To discuss the optimum operation time for ischemic moyamoya disease. Methods The clinical data of 41 patients with ischemic moyamoya disease underwent revascularization at the Department of Neurosurgery, Renmin Hospital of Wuhan University from June 2016 to May 2018 were analyzed retrospectively. Considering the time interval between acute onset of moyamoya disease and surgery, all patients were divided into early group and later group(>90 days between MMD onset and surgery). The post-operation complication(Cerebral hemorrhage, Cerebral infarction, Cerebral hyperperfusion), and the effective of operation(the score of NIHSS, the improvement of perfusion) were compared between groups to estimate optimum operative time of revascularization. Results Compared with the later group, the difference was statistically significant in early group about the improvement of perfusion and neurofunction( P <0.05 ), the values were 0.00 and 0.01, respectively. There was no obvious difference about post-operation complication between early group(52.9%) and later(54.2%) group. Conclusions It seems more reasonable to operate for early revasculization for patients with ischemic moyamoya disease.It can improve surgical efficacy and the risk of postoperative hyperperfusion, cerebral infarction and cerebral hemorrhage may not increase.