联合搭桥手术治疗烟雾病的手术时机和疗效的相关性研究

Correlation between operative timing and efficacy of combined bypass surgery for moyamoya disease

目的对比Suzuki分期早期和晚期症状性烟雾病患者行联合搭桥手术的手术疗效,初步探讨症状性烟雾病患者手术时机和疗效的相关性。方法回顾性分析本科2015年6月至2018年10月收治的症状性烟雾病患者58例,共70侧半球。根据Suzuki分期,将患者分为早期组(Suzuki分期Ⅰ~Ⅲ期)和晚期组(Suzuki分期Ⅳ~Ⅵ期)。患者均行联合搭桥手术;分析两组患者围手术期并发症发生率、术后6个月改良Rankin量表(Modified Rankin Scale,mRS)评分、再次卒中、术后症状改善情况等差异。结果早期组围手术期总的并发症发生率、脑高灌注综合征及围手术期脑出血发生率明显低于晚期组(28.6%vs 57.1%、14.3%vs 35.7%、0%vs 10.7%,P<0.05);早期组术后6个月mRS评分0~2分患者多于晚期组(85.7%vs 64.3%,P=0.036);两组术后症状改善率无明显差异(65.6%vs 68.4%,P=0.838);两组患者在术后随访过程中均未出现再次卒中。结论症状性烟雾病患者选择在Suzuki分期早期行搭桥手术,不仅可减少围手术期并发症发生,而且早期行手术治疗患者预后更好,可能为最佳搭桥手术时机。

Objective To compare the surgical efficacy of combined bypass surgery for symptomatic moyamoya disease patients at early and late Suzuki stage, and to preliminarily explore the correlation between operative timing and efficacy. Methods A retrospective analysis was performed on 58 patients(70 hemispheres) with symptomatic moyamoya disease treated with combined bypass surgery in our department from June 2015 to October 2018. According to the results of Suzuki staging system for moyamoya disease, they were divided into early stage group(stage Ⅰ~Ⅲ, 42 hemispheres) and late stage group(stage Ⅳ~Ⅵ, 28 hemispheres). Superficial temporal artery-to-middle cerebral artery bypass with encephalo-duro-myo-synangiosis(STA-MCA bypass+EDMS) were performed for all patients. The perioperative complications, and improvement of symptoms, recurrence of stroke, and prognosis score(Modified Rankin Scale, mRS) in 6 months after the operation were assessed and compared between the 2 groups. Results The incidences of total perioperative complications, cerebral hyperperfusion syndrome and perioperative cerebral hemorrhage was significantly lower in the early stage group than the late stage group(28.6% vs 57.1%, 14.3% vs 35.7%, 0 vs 10.7%, respectively, P<0.05). There were more patients with mRS score of 0~2 at 6 months after surgery in the early stage group than those in the late stage group(85.7% vs 64.3%, P=0.036). No obvious difference was seen in the improvement rate of postoperative symptoms between the 2 groups(65.6% vs 68.4%, P=0.838). No stroke occurred in the both groups during postoperative follow-up. Conclusion Bypass surgery can not only reduce the incidence of perioperative complications, but also obtain better prognosis for the early Suzuki stage patients with symptomatic moyamoya disease. Early Suzuki stage should be optimal operative time for bypass surgery.