成人缺血型烟雾病22例手术治疗效果
Surgical Treatment of Ischemic Moyamoya Disease in 22 Adult Patients
-
摘要: 目的 观察成人缺血型烟雾病 (IMMD) 的外科手术治疗效果.方法 筛选2014年1月至2015年12月昆明医科大学第一附属医院收治的IMMD经手术治疗成人患者22例, 其中15例行颞浅动脉硬-颞浅筋膜-脑贴敷术 (E-STA-STF-S) 治疗, 7例行颞浅动脉-大脑中动脉搭桥术 (STA-MCA) 治疗.比较手术治疗前后颅脑DSA检查结果及临床症状改善状况.结果 全部患者术后均随访观察39个月不等.15例行E-STA-STF-S患者, 12例术后3个月行颅脑DSA示颈外动脉向颅内代偿供血良好, 症状明显缓解, 3例血供代偿不明显;7例行STA-MCA患者, 1例血供代偿不明显.术后复查颅脑DSA示血供代偿有效率为81.82%, 且临床症状均有所改善.结论 手术治疗能有效改善成人IMMD患者的临床症状, 制定个体化的手术方案是治疗成人IMMD的重要临床措施.
-
关键词:
- 烟雾病 /
- 手术治疗 /
- 颞浅动脉-颞浅筋膜-脑贴敷术 /
- 颞浅动脉-大脑中动脉搭桥术
Abstract: Objective To observe and analyze the surgical treatment of ischemic moyamoya disease (IMMD) in adult patients.Method The clinical data of 22 patients with surgical treatment of ischemic moyamoya disease (IMMD) from January, 2014 to December, 2015 were analyzed retrospectively, 15 cases with Encephalo-STA-STF-synangiosis (E-STA-STF-S) surgery and 7 cases with superficial temporal artery-middle cerebral artery bypass (STA-MCA) surgery. Results Follow-up was conducted 3-9 months after the operation.In 15 cases with E-STA-STF-S surgery, digital subtraction angiography (DSA) showed good compensatory blood supply of external carotid artery to brain and relieved symptoms in 12 patients and no obvious compensation was found in another 3 cases. In 7 cases with STA-MCA surgery, no obvious compensation was found 1 case. After the review of DSA, the compensatory blood supply rate was 81.82% and symptoms were improved in all the cases.Conclusions Surgical treatment can effectively improve the clinical symptoms in adult patients with IMMD. To develop individualized surgical plan is an important clinical measure for IMMD treatment in adult patients. -
[1] 谯飞, 游潮, 李浩, 等.烟雾病的现状和最新认识[J].华西医学, 2012, 27 (3) :151-153. [2] [2]KLEINLOOG R, REGLI L, RINKEL G J, et al.Regional differences in incidence and patient characteristics of moyamoya disease:a systematic review[J].J Neurol Neurosurg Psychiatry, 2012, 83 (5) :531-536. [3] [3]TAKAHASHI J C, MIYAMOTO S.Moyamoya disease:recent progress and outlook[J].Neurol Med Chir (Tokyo) , 2010, 50 (9) :824-832. [4] [4]MATSUSHIMA T, INOUE K, KAWASHIMA M, et al.History of the development of surgical treatments for moyamoya disease[J].Neurol Med Chir (Tokyo) , 2012, 52 (5) :278-286. [5] [5]ROBERTSON R L, BURROWS P E, BARNES P D, et al.Angiographic changes after pial synangiosis in childhood moyamoya disease[J].AJNR Am J Neuroradiol, 1997, 18 (5) :837-845. [6] [6]KIM S K, CHO B K, PHI J H, et al.Pediatric moyamoya disease:An anal-ysis of 410 consecutive cases[J].Ann Neuro, 2010, 68 (1) :92-101. [7]刘鸿飞, 赵浩, 翟乃池.颅骨多处钻孔术在29例烟雾病治疗中的应用研究[J].现代预防医学, 2012, 39 (9) :2330-2331. [8]丁大成, 陈谦学, 秦军, 等.高压氧辅助STA-MCA搭桥术治疗烟雾病的临床疗效[J].中国临床神经外科杂志, 2014, 19 (12) :719-722. [9] [9]SCOTT RM, SMITH ER.Moyamoya disease and moyamoya syndrome[J].N Engl J Med, 2009, 361 (1) :1226-1237. [10]杜彦挺, 潘亚文.Moyamoya病的诊断和治疗的研究进展[J].中国临床神经外科杂志, 2015, 20 (12) :761-763. [11] [11]KIM S J, HEO K G, SHIN H Y, et al.Association of thyroid au-toantibodies with moyamoya-type cerebrovascular disease:a prospective study[J].Stroke, 2010, 41 (1) :173-176. [12] [12]BABA T, HOUKIN K, KURODA S.Novel epidemiological features of moyamoya disease[J].J Neurol Neurosurg Psychiatry, 2008, 79 (8) :900-904. [13] [13]YAMASHITA M, OKA K, TANAKA K.Histopathology of the brain vascular network in moyamoya disease[J].Stroke, 1983, 14 (1) :50-58. [14] [14]SEOL H J, WANG K C, KIM S K, et al.Familial occurrence of moyamoya disease:a clinical study[J].Childs Nerv Syst, 2006, 22 (9) :1143-1148. -
点击查看大图
计量
- 文章访问数: 2127
- HTML全文浏览量: 731
- PDF下载量: 55
- 被引次数: 0
下载:
