联合血运重建术治疗老年烟雾病患者的临床结果及有效性分析

Analysis of clinical outcomes and effectiveness of combined revascularization in the treatment of elderly patients with moyamoya disease

目的分析老年烟雾病患者的发病特点及行联合血运重建术后的临床结局,评估该术式对老年患者的安全性和有效性。方法选取2016年1月至2021年9月于航空总医院神经外科中心行联合血运重建术且初次手术年龄大于等于60岁的烟雾病患者为研究对象,进一步收集这些患者的相关临床资料及术后2周内并发症,并进行随访,与以往报道进行对比。结果30例患者共行46例次联合血运重建术,手术时年龄60~75岁,平均(66.1±4.4)岁,术后2周内并发症发生率为37%,其中最常见为言语功能障碍,其次为癫痫及过度灌注,未出现脑出血及死亡等严重并发症。术后随访3~67个月,平均(26.8±18.4)个月,术后3个月时改良Rankin量表(MRS)评分均<3分,无死亡及重残疾病例。结论老年烟雾病患者围手术期并发症发生率较其他人群高,但经围手术期严密管理2周内基本均可恢复,术后3个月及以上随访效果满意,临床症状明显改善。

Objective To analyze the characteristics of elderly patients with moyamoya disease and clinical outcomes after combined revascularization,and to evaluate the safety and efficacy of this method in elderly patients.Methods Moyamoya disease patients aged 60 years or older who had undergone combined revascularization at the Neurosurgery Center of Aeronautical General Hospital from January 2016 to September 2021 were selected as study subjects.Then patients'clinical data and postoperative complications within two weeks of surgery were collected and a followed-up was conducted.The results were compared with those of previous reports.Results A total of 46 combined revascularization procedures were carried out in 30 patients.The ages at surgery ranged between 60-75 years,with a mean age of(66.1±4.4)years.The rate of complications within two weeks after surgery was 37%,and the most common complication was speech dysfunction,followed by epilepsy and hyperperfusion.No serious complications such as cerebral hemorrhage and death occurred.The follow-up varied between 3-67 months,with an average follow-up time of(26.8±18.4)months.The MRS score was<3 at 3 months after surgery,and there was no death or severe disability.Conclusions Perioperative complications in elderly patients with moyamoya disease have a higher incidence rate than in other populations,but patients can usually recover after close perioperative management for 2 weeks.The follow-up has demonstrated that outcomes at 3 months and in longer terms after surgery are satisfactory and clinical symptoms will improve significantly.