颞浅动脉-大脑中动脉搭桥联合带蒂颞顶筋膜贴敷术治疗成人烟雾病的疗效分析(附18例临床病例分析)

Effect analysis of superficial temporal artery(STA)-middle cerebral artery(MCA)bypass combined with pedicled temporal parietal fascia application in the treatment of adult moyamoya disease(Analysis of 18 clinical cases)

目的 探讨颞浅动脉-大脑中动脉(STA-MCA)搭桥联合带蒂颞顶筋膜贴敷联合治疗烟雾病的有效性及安全性。方法 回顾性分析2021年01月至2023年06月在焦作市人民医院神经外科二区行STA-MCA搭桥联合带蒂颞顶筋膜贴敷联合治疗的18例烟雾病患者临床资料。所有患者于术前行头部PWI、DWI、DSA检查,mRS量表评估生活质量,收集患者围手术期并发症情况,术后6月随访,评估患者恢复情况。结果 18例均顺利完成手术,吻合血管通畅率100%,术后出血1例,梗塞3例,癫痫1例,高灌注综合征2例,死亡0例,切口愈合不良2例,术后6月后症状改善12例,脑灌注改善14例,mRS评分(1.16±1.50)显著低于术前评分(2.11±1.60)(P≤0.05)。结论 STA-MCA搭桥联合带蒂颞顶筋膜贴敷可以安全有效治疗烟雾病,并发症较低。

Objective To investigate the efficacy and complications of superficial temporal artery(STA)-middle cerebral artery bypass combined with pedicled temporal parietal fascia flap(TPFF)in the treatment of Moyamoya disease(MMD).Methods A retrospective analysis was performed on 18 patients with moyamoya disease bypass in the second section of neurosurgery Department of Jiaozuo People's Hospital from January 2021 to June 2023.Preoperative PWI,DWI and DSA examinations were performed on the head,preoperative quality of life was assessed by mRS,postoperative complications were counted,and mRS Scores were performed at discharge.PWI and DSA examinations were performed six months after the operation,and the recovery was evaluated by mRS Score and Matsushima grading.Results All the 18 cases successfully completed the operation,anastomotic vascular patency rate was 100%,postoperative hemorrhage in 1 case,infarction in 3 cases,epilepsy in 1 case,hyperperfusion syndrome in 2 cases,death in O cases,poor incision healing in 2 cases,symptoms improved in 12 cases,cerebral perfusion improved in 14 cases,mRS Score was significantly improved than before surgery,there were significant differences.Conclusion STA-MCA bypass combined with pedicled temporoparietal fascia flap is a safe and effective treatment for moyamoya disease with lowcomplications.