出血型烟雾病累及后循环病变的临床特征及手术疗效研究

发布时间：2018-06-06 16:50

  本文选题：烟雾病 + 出血　； 参考：《中国人民解放军军事医学科学院》2015年硕士论文

【摘要】：目的本研究对出血型烟雾病累及大脑后循环病变患者的一般资料、临床及影像资料进行回顾性分析,进而探讨出血型烟雾病累及后循环病变患者的临床及影像学特征;并对患者进行术后随访,评估其手术效果。方法回顾性分析2002年12月—2011年12月期间军事医学科学院附属医院收治的烟雾病患者,并根据患者的头颅CT及头颅MRI,从中筛选出血型患者224例,对224例患者DSA影像资料进行判读,获得后循环受累的患者57例,未受累患者167例。对受累组与未受累组的年龄、性别、成人比、出血类型、前循环的铃木分期、出血侧异常血管扩张情况进行统计学分析;并对患者进行电话或信件随访,对其中40例行双侧EDAS术患者的手术前后的m RS评分进行统计学分析。结果1.224例烟雾病患者占同期收治的烟雾病患者的14.24%,其中101例患者为男性,123例患者为女性,其比例为1:1.22,患者入院时的年龄为1-57岁。并获得57例(25.45%)累及后循环病变,其中21例患者为男性,36例患者为女性,其比例1:1.71,患者入院年龄为13—56岁,其中54例(94.74%)患者为成人。167例(75.55%)后循环未受累,其中80例患者为男性,67例患者为女性,其比例为1:1.0875,患者入院年龄为1-57岁,其中156例(93.41%)患者为成人。后循环受累组与未受累组在性别比(P0.05)、成人比(P0.05)年龄(P0.05)分布方面均无明显差异。2.本组224例烟雾病患者中,脑室出血85例;蛛网膜下腔出血34例;脑实质出血105例(丘脑出血25例,基底节出血44例,脑叶出血36例)。其中后循环受累组患者中脑叶出血0例,丘脑出血25例,基底节出血2例,脑室出血22例,蛛网膜下腔出血8例;后循环未受累组患者中脑叶出血36例,丘脑出血0例,基底节出血42例,脑室出血63例,蛛网膜下腔出血26例。其中29例(50.9%)表现为单侧大脑后动脉受累,出血类型分别为蛛网膜下腔出血3例(10.3%,1例对侧出血),丘脑出血14例(48.3%,无对侧出血),脑室出血12例(41.4%,3例对侧出血)。后循环受累组患者的出血类型多为丘脑出血(43.86%)及脑室出血(38.60%)且丘脑出血与后循环受累具有统计学差异(P0.01);3.对224例出血型烟雾病患者的颈内动脉铃木分期统计,57例后循环受累组颈内动脉铃木分期为:3期3例,4期7例,5期24例,6期23例;后循环受累组的患者的铃木分期多集中在5(42.1%)、6(40.4%)期;167例后循环未受累组颈内动脉铃木分期为:2期30例,3期52例,4期70例,5期7例,6期8例;后循环未受累组患者的铃木分期处于3(31.1%)、4(41.9%)期的较多,并使用等级资料两样本比较的Wilcoxon秩和检验统计分析,后循环是否受累在铃木分期分布方面具有统计学差异(P0.01);4.对57例出血型烟雾病累及后循环病变患者的大脑后循环分期进行统计,后循环受累组后循环病变分期左侧0期10例(17.5%),1期10例(17.5%),2期9例(15.8%),3期16例(28.1%),4期12例(21.0%);右侧0期19例(33.3%),1期8例(14.0%),2期9例(15.8%),3期14例(24.6%),4期7例(12.3%)。对每名患者的大脑前后循环左右侧病变程度进行对比,发现24例患者中的前后循环病变出现偏侧性。在这24例患者中,有20例(83.33%)患者出现前后循环病变在同一侧,但是有4例(16.67%)患者前后循环病变出现在对侧,并根据颈内动脉铃木分期及大脑后动脉分期左右严重程度进行分组,显示出57例患者的前后循环病变的偏侧性关系。显示这前后循环病变在统计学分析中有很大可能会出现在同一侧,及左右侧的一致性并具有差异性(P0.01);5.57例出血型烟雾病后循环受累组患者中,出血同侧表现了脉络膜前动脉扩张的患者11例,后交通动脉开放的患者21例,脉络膜后动脉扩张的患者47例,后胼周动脉开放的患者45例;167例出血型烟雾病后循环未受累患者中,出血同侧表现了脉络膜前动脉的扩张的患者61例,出血同侧后交通动脉开放的患者115例,脉络膜后动脉扩张的患者5例,后胼周动脉开放的患者134例,异常血管扩张或开放情况与后循环是否受累具有一定的相关性(P0.05),并发现后循环受累组患者的出血同侧多表现出脉络膜后动脉扩张、后胼周动脉开放。发现后循环受累情况与同侧后胼周动脉开放情况无相关性(P=0.833),后循环受累情况多与同侧脉络膜后动脉扩张情况具有相关性(P0.01),后循环受累的患者较少出现后交通动脉开放(P0.01);6.57例后循环病变的患者中,1人右侧STA-MCA术,左侧EDAS术,并行枕部贴敷术;41人行双侧EDAS术;9人行双侧EDAS术+枕部血管贴敷术;4例行单侧EDAS术;2例未行手术。7.57例患者进行术后电话或信件随访,平均随访时间35.8月(8-102月),其中失访4例,2例未行手术,1例仅行单侧EDSA术,1例行双侧EDSA术。对40例双侧EDAS术患者的手术前后m RS评分,术前0分10例、1分18例、2分8例、3分2例、4分2例、5分0例、6分0例,术后0分18例、1分12例、2分6例、3分1例、4分1例、5分1例、6分1例。患者术后m RS评分明显低于术前m RS评分(P=0.01),有2例(5%)患者术后出现再出血。结论后循环受累的出血型烟雾病并不少见,且以成人女性较为多见;烟雾病累及后循环病变的患者前循环铃木分期多为晚期,且后循环病变具有偏侧性,即前后循环病变严重程度具有一定的一致性,烟雾病的病情发展,同侧会出现后循环病变;累及后循环病变的出血类型多为丘脑出血和脑室出血;累及后循环病变的患者出血原因可能与脉络膜后动脉扩张有关;该组出血型烟雾病累及后循环病变患者经EDAS术治疗,临床症状改善显著,再出血率较低。
[Abstract]:Objective to review the general data, clinical and imaging data of patients with hemorrhagic moyamoya disease involving the posterior circulation of the brain, and to explore the clinical and imaging features of patients with blood type moyamoya disease involving the recurrent pathological changes, and to follow up and evaluate the effect of the patients after the operation. Methods a retrospective analysis was made in December 2002. In December 2011, the patients with moyamoya disease in the Affiliated Hospital of Military Medical Science Academy of the PLA were selected from the patient's head CT and head MRI. 224 cases of blood type were selected from the patients. 224 cases of DSA images were read, 57 cases of posterior circulation affected, 167 cases of unaffected patients. The adult ratio, the type of bleeding, the SUZUKI staging of the anterior circulation, and the abnormal vascular dilatation in the hemorrhagic side were statistically analyzed, and the patients were followed up by telephone or letter, and the m RS score of 40 patients before and after the bilateral EDAS operation was statistically analyzed. Results 1.224 cases of moyamoya disease accounted for 14.24 of the patients with moyamoya disease in the same period. 101 cases were male and 123 patients were women with a proportion of 1:1.22, the age of admission was 1-57 years, and 57 cases (25.45%) involved the posterior circulation disease, 21 cases were male, 36 patients were women, and the proportion was 1:1.71, the age of admission was 13 to 56 years old, 54 (94.74%) patients were adult.167 cases (75.55%). The circulation was not involved, of which 80 were male and 67 were female, the proportion was 1:1.0875, the age of admission was 1-57 years, of which 156 cases (93.41%) were adults. There were no significant differences in the sex ratio (P0.05) and the P0.05 age (P0.05) distribution between the posterior circulation and the uninvolved groups in the group of 224 cases of moyamoya disease, the brain was in the brain. 85 cases of ventricular hemorrhage, 34 cases of subarachnoid hemorrhage, 105 cases of cerebral parenchyma hemorrhage (25 cases of thalamic hemorrhage, 44 cases of basal ganglia hemorrhage, 36 cases of cerebral lobes), including 0 cases of cerebral lobes bleeding in the patients with posterior circulation involvement, 25 cases of thalamus hemorrhage, 2 cases of basal ganglia hemorrhage, 22 cases of ventricle hemorrhage, 8 cases of arachnoid hemorrhage, and 36 of cerebral lobes in the patients with posterior circulation unaffected group 36 There were 0 cases of thalamic hemorrhage, 42 cases of basal ganglia hemorrhage, 63 cases of ventricle hemorrhage and 26 cases of subarachnoid hemorrhage, of which 29 cases (50.9%) showed unilateral posterior cerebral artery involvement in 3 cases (10.3%, 1 cases of lateral hemorrhage), 14 cases of thalamic hemorrhage (48.3%, no side bleeding), 12 cases of cerebral hemorrhage (41.4%, 3 cases to side bleeding). The bleeding types of the patients in the circulatory group were thalamic hemorrhage (43.86%) and ventricle hemorrhage (38.60%), and thalamus hemorrhage and posterior circulation were statistically different (P0.01); 3. to 224 cases of hemorrhagic type moyamoya patients, the internal carotid artery SUZUKI staging, 57 cases of the posterior circulation of the internal carotid artery SUZUKI staging: 3 stage 3 cases, 4 phase 7 cases, 5 24 cases, 6 period. In 23 cases, the SUZUKI staging of the patients in the posterior circulation group was concentrated in 5 (42.1%), 6 (40.4%), and 167 cases of the posterior circulation unaffected group of the internal carotid artery, SUZUKI staging, 30 cases, 52 cases, 4 phase 70, 5 period 70, SUZUKI stages in the posterior circulation unaffected group, and the use of grade data for comparison. The Wilcoxon rank sum test statistical analysis showed that the posterior circulation was statistically different in the SUZUKI staging distribution (P0.01); 4. the posterior circulation staging of the patients with 57 cases of moyamoya disease involving the posterior circulation lesion was statistically analyzed, 10 cases on the left side of the posterior circulation lesion stage (17.5%), 10 cases (17.5%) in the 1 stage, 9 cases (15.8%) in the 2 stage. 3 stage 16 cases (28.1%), 4 stage 12 cases (21%), 0 stage 19 cases (33.3%), 1 8 cases (14%), 2 period 28.1% periods. The anterior and posterior circulation lesions were on the same side, but there were 4 cases (16.67%) of the anterior and posterior circulation lesions on the contralateral side. According to the SUZUKI staging of the internal carotid artery and the severity of the posterior cerebral artery staging, the lateral relationship between the anterior and posterior circulation lesions of the 57 patients was shown. It may appear on the same side, and the left and right side of the consistency and difference (P0.01); of the 5.57 cases of hemorrhagic moyamoya disease after the circulation of the group of patients, bleeding on the same side of the anterior choroidal artery dilatation in 11 cases, posterior communicating artery 21 cases, 47 cases of posterior choroidal artery dilatation, and the posterior corpus arteria open patients 45 In 167 cases of unaffected circulatory blood type moyamoya disease, 61 cases of dilatation of the anterior choroidal artery were displayed on the same side of hemorrhage, 115 cases of hemorrhage identical with posterior communicating artery, 5 cases of posterior choroidal artery dilatation, 134 patients with open peripheral artery artery, abnormal vasodilatation or opening and posterior circulation. There was a certain correlation (P0.05), and it was found that the bleeding on the same side of the patients with the posterior circulation showed the expansion of the posterior choroidal artery and the opening of the posterior corpus arteria. It was found that there was no correlation between the post circulation involvement and the opening of the corpus callus at the same side (P=0.833). The situation of the posterior circulation was much more than the same side of the posterior choroidal artery dilatation. P0.01, posterior circulation affected patients had less posterior communicating artery (P0.01); of the 6.57 patients with posterior circulation, 1 had right side STA-MCA, left EDAS, and parallel occipital plaster; 41 had bilateral EDAS; 9 had bilateral EDAS and occipital vascular plaster; 4 unilateral EDAS; 2 non operative.7.57 patients after operation. The follow-up time of telephone or letter was 35.8 months (8-102 months), of which 4 cases were lost, 2 cases were not operated, 1 cases only unilateral EDSA and 1 case of bilateral EDSA. The m RS before and after operation in 40 cases of bilateral EDAS operation, 0 in 10 cases before operation, 1 points, 2, 8 cases, cases There were 1 cases, 4 points, 1 cases, 5 points and 1 cases, 6 points 1 cases. The m RS score of the patients was significantly lower than the preoperative m RS score (P=0.01), and 2 cases (5%) had rebleeding after operation. Conclusion the posterior circulation affected moyamoya disease was not uncommon, and the adult female was more common; the anterior circulation SUZUKI staging of the patients with moyamoya disease involved the posterior circulation. The circulatory lesions are biased, that is, the severity of the anterior and posterior circulation diseases has certain consistency, the development of the moyamoya disease and the posterior circulation lesion in the ipsilateral. The types of hemorrhagic disease involving the posterior circulation are mostly thalamus hemorrhage and ventricle hemorrhage, and the cause of the bleeding of the patients involving the posterior circulation may be related to the dilatation of the posterior choroidal artery. After EDAS treatment, the clinical symptoms improved significantly and the rebleeding rate was lower.
【学位授予单位】：中国人民解放军军事医学科学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.12
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本文编号：1987435