直接搭桥对比联合搭桥治疗成人缺血型烟雾病的疗效

Effect of direct bypass and combined bypass surgery for adult ischemic Moyamoya disease

目的比较直接搭桥与联合搭桥治疗成人缺血型烟雾病的疗效。方法分析2014年至2018年于山东大学齐鲁医院行直接或颞肌贴敷并脑膜翻转术(EDMS)法联合搭桥的成人缺血型烟雾患者204例的病历资料,包含129侧直接搭桥(颞浅动脉-大脑中动脉搭桥),113侧联合搭桥(颞浅动脉-大脑中动脉搭桥+EDMS),其中38例患者接受双侧搭桥手术。通过脑血管造影的松岛分级,Kaplan-Meier生存分析评估2组患者的手术效果,采用Logistic回归模型分析影响血管生成的因素。结果 2组患者血管生成上各松岛分级差异无统计学意义(P=0.494)。松岛分级3级的患者中,联合搭桥组血管生成能力明显优于直接搭桥组(P=0.048)。年龄(OR=0.917,95%CI:0.888~0.945,P<0.001)和术前是否存在颅内外血管代偿(OR=2.736,95%CI:1.560~4.881,P<0.001)是影响血管生成的独立影响因素。结论对于成人缺血型烟雾病,联合搭桥与直接搭桥在血管生成方面无明显差别,对年轻患者或术前存在颅内外血管代偿的患者推荐采用直接搭桥。

Objective To compare the efficacy of direct bypass and combined bypass with encephalo-duro-myo-synangiosis(EDMS) bypass in the treatment of adult ischemic Moyamoya disease.Methods The medical records of 204 adult patients with ischemic Moyamoya disease who underwent direct or combined bypass in Qilu Hospital of Shandong University from 2014 to 2018 were analyzed. A total of 242 hemispheres were treated, which included 129 hemispheres which underwent direct bypass(superficial temporal artery-middle cerebral artery bypass, STA-MCA bypass) and 113 hemispheres which underwent combined STA-MCA bypass with EDMS. Among them, 38 patients underwent bilateral bypass surgery. Through the Matsushima grading of cerebral angiography and Kaplan-Meier survival analysis, the surgical effect of the two groups was evaluated. The factors affecting angiogenesis were analyzed by Logistic regression model. Results There was no significant difference in angiogenesis between the two groups(P=0.494). As for patients with Matsushima grade 3, angiogenesis in the combined bypass group was significantly better than that in the direct bypass group(P=0.048). Age(OR=0.917, 95% CI: 0.888~0.945, P<0.001) and whether there is extracranial vascular compensation(OR=2.736,95% CI: 1.560~4.881, P<0.001)is an important factor affecting angiogenesis. Conclusion For adult ischemic Moyamoya disease, there is no significant difference in angiogenesis between combined bypass and direct bypass treatment. Direct bypass is recommended for young patients or patients with intracranial and extracranial vascular compensation before operation.