联合脑血运重建术治疗儿童烟雾病的疗效

Efficacy of combined cerebral revascularization in the treatment of children moyamoya disease

目的观察联合脑血运重建术治疗儿童烟雾病的临床疗效。方法回顾性分析2020-01—2021-12河南省人民医院烟雾病诊疗中心收治的儿童烟雾病(年龄8~15岁)14例,收集和分析患儿的一般资料、临床特征、围术期并发症和改良Rankin量表(mRS)评分。结果14例儿童烟雾病共行25次手术,其中21次联合脑血运重建术,1次手术后患儿出现一过性癫痫发作,1次手术后患儿出现头皮局部坏死,2次手术后患儿出现小梗死,无大梗死和脑出血等严重并发症。术后中期随访DSA显示,颈外动脉系统通过桥血管和颞中、深动脉向脑皮层代偿供血,PWI显示脑灌注缺血情况不同程度改善;术后4例(28.57%)患儿神经功能缺损症状得到改善,9例(64.29%)患儿症状稳定,未再出现新发的神经功能缺损症状,1例(7.14%)患者出现新的神经功能缺损症状。结论联合脑血运重建术治疗儿童烟雾病较安全,可以明显改善脑灌注情况,中期随访效果好。

Objective To investigate the clinical effect of combined cerebral revascularization in the treat⁃ment of children moyamoya disease.Methods Fourteen children moyamoya disease patients in Henan Provincial People's Hospital from January 2020 to December 2021 were analyzed retrospectively.The clinical features,score of modified Rankin Scale(mRS)and perioperative complications were collected.Results A total of 25 operations were performed in 14 cases of children moyamoya disease,of which 21 were combined cerebral revascularization.Transient epileptic seizure occurred after 1 operation,local scalp necrosis occurred after 1 operation,and minor in⁃farction occurred after 2 operations,without major infarction or cerebral hemorrhage and other serious complica⁃tions.DSA showed that the external carotid artery system compensated blood supply to the cerebral cortex,and PWI showed that cerebral perfusion ischemia improved to varying degrees.After surgery,4 children(28.57%)had improved neurological deficits,9 children(64.29%)had stable symptoms without new neurological deficits,and 1 patient(7.14%)had new neurological deficits.Conclusion Combined cerebral revascularization is safe in the treatment of children with moyamoya disease,can significantly improve cerebral perfusion,with good mid-term follow-up results.