中期烟雾病的复合血管重建术与保守治疗

Combined revascularization versus conservative treatment of medium-stage moyamoya disease

目的研究中期烟雾病(MMD)的复合手术治疗与保守治疗的优劣,并分析远期卒中的危险因素。方法回顾性分析昆明医科大学第一附属医院神经外一科2016年8月—2020年8月收治的Ⅲ期和Ⅳ期MMD患者共67例,根据治疗方式不同分为手术组和保守治疗组,平均随访(22.9±14.7)个月,对比患者入院及随访时的改良Rankin量表(mRS)评分、治疗后的神经功能结局、治疗有效率、治疗满意率、远期卒中情况,并对远期发生卒中的患者行危险因素分析。结果手术组中的出血型MMD比缺血型MMD的mRS评分改善更明显(P=0.01)、远期卒中率更低(P=0.044),保守治疗组中的缺血型MMD比出血型MMD的mRS评分改善更明显(P=0.02);回归分析显示缺血型MMD(P=0.028)和入院前短暂性脑缺血发作(TIA)>1次/周(P=0.006)是远期卒中的危险因素。结论对于中期MMD而言,缺血型MMD行手术治疗不优于保守治疗;出血型MMD行手术治疗能明显改善mRS评分,缺血型MMD患者和入院前TIA>1次/周的MMD患者远期卒中发生率更高。

Objectives To study the advantages and disadvantages of combined revascularization versus conservative treatment for medium-stage moyamoya disease(MMD)and to analyse the risk factors of long-term stroke.Methods A total of 67 patients with stageⅢand IV MMD admitted to the Department of Neurosurgery,the First Affiliated Hospital of Kunming Medical University from August 2016 to August 2020 were analyzed retrospectively.They were divided into operation group and conservative treatment group according to different treatment methods.The average follow-up period was(22.9±14.7)months.The modified Rankin scale(mRs)score,neurological outcome after treatment,treatment efficiency,treatment satisfaction rate,and long-term stroke were compared,and the risk factors of patients with long-term stroke were analyzed.Results The improvement in the mRS score of haemorrhagic MMD patients was more remarkable than that of ischaemic MMD patients(P=0.01),and the long-term stroke rate was also lower(P=0.044).In the conservative treatment group,the changes in the mRS score of ischemic MMD patients were more obvious than those of haemorrhagic MMD patients(P=0.02).A regression analysis showed that ischaemic MMD(P=0.028)and transient ischaemic attack(TIA)>1/week before admission(P=0.006)were risk factors for long-term stroke.Conclusions For medium-stage MMD,surgery for haemorrhagic MMD can improve the mRS score when compared with conservative treatment.Patients with ischemic MMD and patients with TIA>1/week before admission are at a higher risk of long-term stroke.