不同手术方式治疗成人烟雾病的临床疗效及并发症分析

Analysis of the clinical effect and complications of different surgical methods in the treatment of adult moyamoya disease

目的通过回顾性分析对比不同方式的血管重建手术对成人烟雾病的临床疗效及并发症分析,为临床治疗烟雾病提供依据。方法选取2009年1月至2018年12月在本院收治的单侧烟雾病患者60例,根据手术方法不同分为3组,各20例。A组实施联合血管重建术,B组实施间接血管重建术,C组实施直接血管重建术。对比术后血管重建效果、磁共振灌注成像的变化、mRS评分、围术期并发症发生率。结果术后指标无论是血管重建效果、血流动力学参数还是mRS评分,A组、C组均优于B组,而A组与C组两组比较差异无统计学意义。A组、C组并发症发生率均明显低于B组,而A组与C组比较差异无统计学意义。结论对于烟雾病的治疗,联合血管的吻合术、直接血管吻合术均优于间接血管吻合术,值得推荐。

Objective To provide evidence for the treatment of moyamoya disease by retrospective analysis and comparison of the clinical efficacy and complications of different methods of vascular reconstruction. Methods 60 patients were selected with unilateral moyamoya disease in our hospital from January 2009 to December 2018. According to the different surgical methods, they were divided into three groups, with 20 cases in each group. The patients in group A underwent combined vascular reconstruction, the patients in group B underwent indirect vascular reconstruction,and the patients in group C underwent direct vascular reconstruction. The effects of vascular reconstruction, changes of MR perfusion imaging, mRS score and the incidence of perioperative complications were compared. Results The postoperative indexes of group A and group C were better than those of group B in terms of vascular reconstruction effect, hemodynamic parameters and mRS score, but there was no significant difference between group A and group C. The incidence of complications in group A and group C was significantly lower than that in group B, but there was no significant difference between group A and group C. Conclusion For the treatment of moyamoya disease, combined vascular anastomosis and direct vascular anastomosis are better than indirect vascular anastomosis.