不同术式治疗成人烟雾病的疗效对比研究

发布时间：2018-05-14 02:21

本文选题：烟雾病 + 外科血管重建　；参考：《郑州大学》2017年硕士论文

【摘要】：目的对比分析颞浅动脉-大脑中动脉搭桥联合颞浅动脉分支贴敷术与脑-硬膜-颞肌血管贴敷术治疗成人烟雾病的安全性及疗效,探讨成人烟雾病外科治疗的最佳手术方式。方法回顾性分析2011年8月至2016年5月在郑州大学第一附属医院神经外科接受外科血管重建术治疗(单侧半球)的118例成人烟雾病患者的完整临床资料,其中采用颞浅动脉-大脑中动脉(superficial temporal artery-middle cerebral artery,STA-MCA)搭桥联合颞浅动脉分支贴敷术(combiend bypass surgery,CBS)51例(CBS组),采用脑-硬膜-颞肌血管贴敷术(Encephalo-duro-myo-synangiosis,EDMS)67例(EDMS组),比较两组患者术后并发症发生率,近期(术后3月)症状缓解率、CTP血流动力学参数变化率,远期(≥术后3月)症状缓解率、再出血发生率、再缺血发生率、血管重建率以及脑血流动力学参数变化率,随访时间为3月~67月,平均(22.3±2.1)月。定量资料组间比较采用t检验或校正的t检验、配对t检验或非参数配对wilcoxon检验,定性资料组间比较采用χ~2检验、Kruskal-Wallis秩和检验或χ~2检验连续校正(Yates校正),P0.05为差异有统计学意义。结果1.CBS组术后并发症发生率(33.3%,17/51)高于EDMS组(13.4%,9/67),主要表现为高灌注综合征(CHS),差异有统计学意义(χ~2=6.676,P0.05);2.术后近期CBS组症状缓解率(86.3%)高于EDMS组(40.3%),差异有统计学意义(H=31.199,P0.05);3.CTP相关参数变化:CBS组术后短期内CBF、r CBF较术前增加,TTP及r TTP较术前缩短,差异均有统计学意义(P0.05),CBV、r CBV较术前减少,差异无统计学意义(P0.05);EDMS组术后短期内CBF、r CBF较术前增加,CBV、r CBV较术前减少,差异均无统计学意义(P0.05),TTP及r TTP较术前缩短,差异均有统计学意义(P0.05);术后早期,CBS组与EDMS组相比CBF、r CBF增加更为明显,差异有统计学意义(P0.05);术后远期,CBS组平均CBF高于EDMS组,差异有统计学意义(P0.05);4.术后远期CBS组术前症状缓解率(92.2%)高于EDMS组(79.1%),差异有统计学意义(H=5.783,P0.05);5.CBS组总体术后远期出血率(5.9%)低于EDMS组(9.0%),差异无统计学意义(χ~2=0.074,P0.05);CBS组中出血型MMD再出血率(6.7%)低于EDMS组中出血型MMD再出血率(12.2%),差异无统计学意义(χ~2=0.136,P0.05);6.CBS组中缺血型MMD再缺血率(4.8%)低于EDMS组中缺血型MMD再缺血率(11.5%)差异无统计学意义(χ~2=0.091,P0.05);7.CBS组术后血管重建有效率(92.2%)高于EDMS组(61.2%),差异有统计学意义(H=20.705,P0.05);8.CBS组中3例未处理的周围型动脉瘤,2例消失、1例较术前缩小;EDMS组中2例未处理的周围型动脉瘤,复查DSA发现全部消失。研究结论1.颞浅动脉-大脑中动脉搭桥联合颞浅动脉分支贴敷术(CBS)与脑-硬膜-颞肌血管贴敷术(EDMS)均是治疗成人缺血型烟雾病的有效手术方式;2.颞浅动脉-大脑中动脉搭桥联合颞浅动脉分支贴敷术(CBS)治疗成人缺血型烟雾病的效果更为确切,具有症状缓解迅速及缓解率高、脑灌注改善明显、血管重建有效率高的优势;3.治疗出血型烟雾病尚不能确定哪种术式更为有效,颞浅动脉-大脑中动脉搭桥联合颞浅动脉分支贴敷术(CBS)可能对出血型烟雾病患者有益,有待进一步研究。4.CBS组术后并发症发生率高于EDMS组,高灌注综合征是CBS术后最常见并发症。
[Abstract]:Objective to compare and analyze the safety and efficacy of superficial temporal artery bypass grafting of middle cerebral artery and superficial temporal artery branch and cerebral dura temporalis myomoyamoy in the treatment of adult moyamoya disease, and to explore the best surgical methods for the surgical treatment of adult moyamoya disease. Methods a retrospective analysis was made in the First Affiliated Hospital of Zhengzhou University from August 2011 to May 2016. The complete clinical data of 118 cases of adult moyamoya disease in the Department of neurosurgery were treated by surgical vascular reconstruction (unilateral hemisphere), of which 51 cases (CBS group) were used in 51 cases (CBS group) with superficial temporal artery (superficial temporal artery-middle cerebral artery, STA-MCA) bridge combined with superficial temporal artery branch application (combiend bypass surgery, CBS). 67 cases (group EDMS) of Encephalo-duro-myo-synangiosis (EDMS) were compared. The rate of postoperative complications was compared between the two groups. The rate of remission of symptoms, the rate of changes of hemodynamic parameters of CTP, the rate of remission of symptoms, the rate of rebleeding, the incidence of rebleeding, the rate of revascularization, the rate of reconstruction of blood vessels, and the blood of brain. The change rate of flow mechanics parameters, the follow-up time was March ~67 months, average (22.3 + 2.1) months. The quantitative data groups were compared by t test or corrected t test, paired t test or non parameter paired Wilcoxon test, the qualitative data groups were compared by the chi square ~2 test, Kruskal-Wallis rank sum test or X ~2 test continuous correction (Yates correction), P0.05 was the difference Results the incidence of postoperative complications in group 1.CBS (33.3%, 17/51) was higher than that in group EDMS (13.4%, 9/67), the main manifestation was high perfusion syndrome (CHS), the difference was statistically significant (~2=6.676, P0.05); the rate of symptomatic relief in group CBS (86.3%) after 2. was higher than that in group EDMS (40.3%), and the difference was statistically significant (H=31.199, P0.05); 3.CTP related parameters were statistically significant. Changes: in group CBS, CBF, R CBF were increased in the short term after operation, and TTP and R TTP were shorter than before operation. The difference was statistically significant (P0.05), CBV, R CBV was less than preoperative, and there was no statistical significance (P0.05). The difference was statistically significant (P0.05). In the early period after operation, the increase of CBF and R CBF in group CBS was more obvious than that in EDMS group, and the difference was statistically significant (P0.05); the average CBF in CBS group was higher than that of EDMS group after operation (P0.05); 4. after operation, the rate of relieving symptom before operation was higher than that of group (79.1%), and the difference was statistically significant Significance (H=5.783, P0.05), group 5.CBS after total postoperative bleeding rate (5.9%) was lower than that in group EDMS (9%), the difference was not statistically significant (x ~2=0.074, P0.05), and the rate of rebleeding of blood type MMD in group CBS was lower than that of MMD rebleeding (12.2%) in group EDMS (12.2%), with no statistical significance (x ~2=0.136, P0.05). There was no significant difference in the ischemic rate of MMD ischemia (11.5%) in group EDMS (x ~2=0.091, P0.05), and the effective rate of vascular reconstruction in group 7.CBS (92.2%) was higher than that of group EDMS (61.2%), the difference was statistically significant (H=20.705, P0.05), 3 cases of untreated circumference aneurysm in group 8.CBS, 2 cases disappeared, 1 cases narrowed before operation, 2 cases in EDMS group were not treated. Peripheral arterioma and DSA found all disappeared. Conclusion 1. the superficial temporal artery - middle cerebral artery bypass grafting combined with superficial temporal artery branch application (CBS) and cerebral dura temporalis vascular patch (EDMS) are effective surgical methods for the treatment of adult moyamoya disease; 2. superficial temporal arteriocerebral artery bypass grafting combined with superficial temporal artery branch Application The effect of operation (CBS) in the treatment of adult moyamoya disease is more accurate, with rapid relief of symptoms, high remission rate, obvious improvement of cerebral perfusion and high effective rate of reconstruction of blood vessels. 3. the treatment of moyamoya disease is not yet more effective. Superficial temporal artery - middle cerebral artery bypass combined with superficial temporal artery patch application (CBS) It is useful for patients with blood type moyamoya disease. It needs to be further studied in group.4.CBS after operation. The incidence of postoperative complications is higher than that in group EDMS. High perfusion syndrome is the most common complication after CBS.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12

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