颞浅动脉-大脑中动脉血管吻合术长期随访研究

发布时间：2018-02-04 21:20

本文关键词： 颞浅动脉大脑中动脉血管吻合术缺血性脑血管病动脉闭塞神经功能障碍　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：背景1967年,Yasargil等首次报道了采用颞浅动脉-大脑中动脉血管吻合术治疗缺血性脑血管病,颅内外血管吻合术为代表的血流重建术曾风靡一时。但1985年,权威杂志《新英格兰杂志》发表了前瞻性、国际多中心、随机、对照临床试验的结论:颅内外血管吻合术并不能减低缺血性脑卒中发病概率,因此,颅内外血管吻合术例数急剧减少,但仍有部分学者始终未放弃对此种术式的探索。进入21世纪后,由于更加精确的定量评价脑血流动力学方法的出现,对于1985年的临床试验结论进行重新评价的呼声不断高涨,国内外众多学者应用全新的技术和理论,不断的去验证颅内外血管吻合术究竟能否改善缺血性脑卒中的发病率。目的通过总结行颞浅动脉-大脑中动脉血管吻合术的术前、术后及3-4年长期随访的资料,比较各个分组之间统计学差异,分析影响疗效的相关因素,以及预后生存情况等方面的问题,以便于寻找更佳的治疗方案,并以此证明颞浅动脉-大脑中动脉血管吻合术在治疗慢性、症状性颈内动脉或大脑中动脉闭塞是否有效和安全。方法回顾性分析我科室自2011年2月至2011年11月间31例行颞浅动脉-大脑中动脉血管吻合术患者的临床资料,记录并统计入组患者的基线资料、手术前后及随访时的影像表现、围手术期不良事件发生情况、远期临床随访过程中缺血性事件发生情况,建立数据库后运用SPSS软件进行统计学分析。通过本研究的结果与国内外类似的研究做对比,证明其有效性和安全性,进而明确治疗理念,改进治疗方式。结果31例均成功行颞浅动脉-大脑中动脉血管吻合术,术后7天内复查脑血管造影,通畅率100%,致残致死率0%。术后3-4年随访发生2例缺血性事件和1例出血性事件,其中与手术侧有关的再发缺血性脑卒中1例(3.22%),发生出血性脑卒中1例(3.22%),卒中发生率为6.45%。在随访期间有15例(48.39%)患者在血管吻合术后行CTA检查,共有1例(3.23%)发生吻合口狭窄,15例吻合血管通畅,通畅率100%。无死亡病例,致残率为3.23%。所有病例均在随访中。通过分别对术前、术后7日、3-4年mRS评分作比较,p=0.023,p=0.01。术前、术后7日、3-4年NIHSS评分作比较,p=0.023,p=0.01,以上均p?0.05,有显著的统计学差异,表明血管吻合术是有效的。对3种动脉闭塞分类检验,差值4 p=0.011(p?0.05):仅仅提示颈动脉闭塞行血管吻合术,术后的长期效果较其他两类好。对3种脑梗死分型检验,差值均p0.05:3种脑梗死分型之间对于血管吻合术总体疗效是相同的。采用K-M法分析表明:随着时间的延长,脑卒中事件的发生率也相应减少。通过Cox风险分析:颈动脉闭塞的类型行手术后预后优于大脑中动脉闭塞或重度狭窄的类型,阿司匹林术后规律口服的病例预后优于停用的病例,而脑梗死类型对于预后影响无统计学意义。结论1.颞浅动脉-大脑中动脉血管吻合术是一种有效且安全的手术方式。2.目前的颞浅动脉-大脑中动脉血管吻合手术只是针对一些主要由供血动脉重度狭窄或闭塞引起的、低灌注、慢血流等血流动力学障碍性缺血性卒中。3.颈内动脉闭塞是行颞浅动脉-大脑中动脉血管吻合术的最佳适应症。4.颞浅动脉-大脑中动脉血管吻合术必须根据患者的具体病情而制定个体化的手术方式,认真详细的术前判断对患者的预后有相当巨大的帮助。
[Abstract]:In 1967, Yasargil first reported the arterial anastomosis of superficial temporal artery middle cerebral blood flow in the treatment of ischemic cerebrovascular disease, reconstruction of intracranial vascular anastomosis as the representative has become fashionable for a time. But on 1985, the authoritative magazine "new England Journal > published prospective, international multi center, randomized, controlled clinical trial conclusion: intracranial vascular anastomosis and cannot reduce the probability of ischemic stroke and intracranial vascular anastomosis were drastically reduced, but there are still some scholars always did not give up this kind of exploration operation. After entering in twenty-first Century, due to more accurate quantitative evaluation of cerebral blood flow dynamics method, the conclusion of the 1985 re trial the evaluation of the voice rising, many scholars at home and abroad application of new technology and theory, to verify the intracranial vascular anastomosis can actually improve The incidence of ischemic stroke. The arterial anastomosis for summarizing the superficial temporal artery in the brain before operation, postoperative and long-term follow-up of 3-4 years, compared with statistical differences between each group, analyze the related factors affecting the efficacy, prognosis and survival situation and other aspects of the problem, in order to find better treatments, and prove that the superficial temporal artery middle cerebral artery anastomosis in the treatment of chronic, symptomatic internal carotid artery or middle cerebral artery occlusion is effective and safe. Methods a retrospective analysis of clinical data of patients in our department from February 2011 to November 2011 between the arterial anastomosis in 31 cases of superficial temporal artery in the brain, and included in the baseline data recording system groups of patients, imaging findings before and after surgery and follow-up, the incidence of perioperative adverse events, the occurrence of ischemic events during long term follow-up, Establish a database using SPSS software for statistical analysis. By contrasting the results of this study at home and abroad are similar, their efficacy and safety, and clear treatment concept, improved treatment. Results 31 cases were successfully treated by superficial temporal artery middle cerebral artery anastomosis, follow-up cerebral angiography within 7 days of surgery later, the patency rate was 100%, the mortality of 0%. after 3-4 years of follow-up 2 cases of ischemic events and 1 cases of hemorrhagic events, including surgery and side related recurrent ischemic stroke in 1 cases (3.22%), 1 cases of hemorrhagic stroke (3.22%), the incidence of stroke in the follow-up period is 6.45%. 15 cases (48.39%) in patients with vascular anastomosis were performed CTA examination, a total of 1 cases (3.23%) had anastomotic stenosis, 15 cases anastomotic patency, the patency rate of 100%. no deaths, the disability rate is 3.23%. in all cases were followed up. Based on the preoperative, After 7 days, 3-4 years mRS score comparison, p=0.023, p=0.01. before operation, postoperative day 7, 3-4 years NIHSS score comparison, p=0.023, p=0.01, P were more than? 0.05, there is a statistically significant difference, indicate that vascular anastomosis is effective. The classification test of 3 kinds of artery occlusion, the difference of 4 p= 0.011 (P? 0.05): only prompt the occlusion of the carotid artery anastomosis, postoperative long-term effect than the other two types. Type test of 3 kinds of cerebral infarction, the difference between all kinds of p0.05:3 types of cerebral infarction for vascular anastomosis the overall effect is the same. By the method of K-M analysis showed that with the extension of time, brain the stroke event rate is reduced by Cox. Risk analysis: carotid artery occlusion type for the prognosis after operation is better than that of middle cerebral artery occlusion or severe stenosis cases of type, oral cases better prognosis than aspirin discontinuation after surgery, and the prognosis for acute cerebral infarction There was no significant effect of artery anastomosis. Conclusion 1. superficial temporal artery middle cerebral is an effective and safe surgical methods at.2. superficial temporal artery middle cerebral artery vascular anastomosis surgery is only for some mainly by the artery stenosis or occlusion caused by the low perfusion, slow blood flow hemodynamics of ischemic stroke.3. occlusion of the internal carotid artery is an artery anastomosis of superficial temporal artery middle cerebral artery anastomosis with.4. best adaptation of superficial temporal artery middle cerebral surgery and must be individualized according to the patient's specific condition, the careful preoperative diagnosis is of great help to the prognosis of the patients.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.12

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