烟雾病颅内外血管重建术后新生血管能力的相关因素分析

Analysis of related factors of neovascularization after extracranial and extracranial vascular reconstruction in moyamoya disease

目的观察颞浅动脉-大脑中动脉分支吻合联合脑-硬脑膜-颞肌血管融合术(STA-MCA+EDMS)与脑-硬脑膜-颞肌血管融合术(EDMS)后疗效及预后对比分析。方法回顾性分析2018年6月—2021年6月南京医科大学附属脑科医院166例行大脑半球行STA-MCA+EDMS联合手术或EDMS间接手术治疗的烟雾病患者。观察两组术式的术后疗效、手术并发症及其远期预后。结果对于梗死型及出血型烟雾病患者,联合手术术后血管造影评分优于间接手术(P=0.009)。进一步对有症状组患者进行ROC曲线分析提示,当年龄>49.5岁时行联合手术对术后血管新生能力差具有一定预测作用(P<0.001)。当年龄>42.5岁时行间接手术,对于术后血管新生能力差具有一定预测作用(P=0.046)。新生血管能力在各铃木分级、梗死型烟雾病、出血型烟雾病及无症状组均无统计学意义(P>0.05)。结论本中心研究提示联合手术对于术后血管的新生能力效果要优于间接手术,对于烟雾病患者应当尽早诊断尽早进行干预治疗。

Objective To observe the efficacy and prognosis after superficial temporal artery-middle cerebral artery anastomosis combined with encephalo-duro-myo-synangiosis compared with encephalo-duro-myo-synangiosis.Methods The clinical data of 166 patients with moyamoya disease(MMD)treated with combined superficial temporal artery-middle cerebral artery anastomosis and encephalo-duro-myo-synangiosis(STA-MCA+EDMS)or indirect encephalo-duro-myo-synangiosis(EDMS)from June 2018 to June 2021 at the Affiliated Brain Hospital of Nanjing Medical University were analyzed retrospectively.The postoperative efficacy,surgical complications and their long-term prognosis of the two groups were observed.Results Postoperative angiographic scores were superior to indirect procedures for patients with ischemic and hemorrhagic MMD(P=0.009)for combined procedures.Further ROC curve analysis of symptomatic patients showed that the combined operation when the age was>49.5 years had a certain predictive effect on the poor ability of postoperative angiogenesis(P<0.001).When the age was more than 42.5 years old,indirect surgery had a certain predictive effect on the poor ability of postoperative angiogenesis(P=0.046).(P>0.05).Conclusion This study suggests that combined operation is better than indirect operation in the neovascularization after operation,and patients should be diagnosed and treated with early intervention.