發(fā)布時(shí)間：2019-05-18 17:44

【摘要】：煙霧�。╩oyamoya disease），又稱腦底異常血管網(wǎng)病，是以腦血管造影發(fā)現(xiàn)雙側(cè)頸內(nèi)動(dòng)脈(internal carotid artery，ICA)虹吸部及大腦前、中動(dòng)脈起始部嚴(yán)重狹窄或閉塞，顱底軟腦膜、穿通動(dòng)脈等小血管代償增生形成腦底異常血管網(wǎng)為特征的一種慢性腦血管閉塞性疾病。明確的煙霧病病因尚不清楚。各國(guó)發(fā)病率、發(fā)病類型、發(fā)病年齡各具特點(diǎn)。數(shù)字減影血管造影(digital subtraction angiography, DSA)為診斷本病的金標(biāo)準(zhǔn)，核磁共振成像(magnatic resonance imaging, MRI)、磁共振血管成像(magnetic resonance angiography,MRA)、計(jì)算機(jī)斷層掃描血管造影術(shù)(computed tomography angiography, CTA)等均對(duì)本病的診斷有較高的敏感性和特異性。依據(jù)不同患者的患病特點(diǎn)，采取適宜的內(nèi)外科治療。 方法：對(duì)2009年1月~2013年12月入住我院的212例煙霧病患者進(jìn)行回顧性調(diào)查研究�；仡櫺哉{(diào)查與其有關(guān)的臨床資料，包括入院時(shí)間、年齡、性別、民族、發(fā)病類型、查體、既往病史、家族史、危險(xiǎn)因素、實(shí)驗(yàn)室及超聲影像學(xué)檢查、治療、出院時(shí)情況等。本研究使用SPSS17.0統(tǒng)計(jì)軟件對(duì)本研究數(shù)據(jù)進(jìn)行分析，計(jì)數(shù)資料采用χ2檢驗(yàn)，p值根據(jù)情況取0.05或0.001。 結(jié)果：1、按照聯(lián)合國(guó)衛(wèi)生組織（world health organization, WHO）年齡劃分，兒童患者5.7%，青年患者35.4%，中老年患者59.0%。中老年患者例數(shù)明顯高于兒童及青年患者例數(shù)�；颊�45~60歲例數(shù)多而集中。2、男性患者49.5%，，女性患者50.5%。男女比例接近1:1，患者總體性別比例無明顯差異。兒童患者組，男性41.7%，女性58.3%；青年患者組，男性45.3%，女性54.7%；中老年患者組，男性52.8%，女性47.2%。兒童組、青年組和中老年組患者性別差異無顯著性。3、高血壓病病史25.5%，接種史89.6%，吸煙史35.8%，飲酒史22.6%，吸煙史同時(shí)有飲酒史17.9%。綜上，患者高血壓病病史、接種史、吸煙史、飲酒史均是發(fā)病的可疑危險(xiǎn)因素。4、兒童患者組，缺血型58.3%，出血型41.7%；青年患者組，缺血型44.0%，出血型56.0%；中老年患者組，缺血型40.0%，出血型60.0%。按照年齡分組，三組內(nèi)兩種發(fā)病類型比例進(jìn)行組間比較，兒童組、青年組和中老年組患者發(fā)病類型差異無顯著性。按照發(fā)病類型分組，缺血型、出血型在不同年齡段的比例比較，缺血型、出血型患者在兒童、青年和中老年患者中分布差異無顯著性。5、實(shí)驗(yàn)室檢查，肝功異常者76.7%，外科綜合異常者7.0%，外科綜合及肝功均異常者16.4%。6、作為初次篩選的影像學(xué)檢查，計(jì)算機(jī)斷層掃描(computed tomography, CT)45.8%、CT聯(lián)合CTA與CT聯(lián)合經(jīng)顱多普勒(transcranial doppler, TCD)共12.7%、MRA與MRA聯(lián)合TCD共11.8%，TCD聯(lián)合頸彩2.8%。以上數(shù)據(jù)可知，CT、CT聯(lián)合CTA、CT聯(lián)合TCD、MRA、MRA聯(lián)合TCD，作為初次篩選檢查在臨床中應(yīng)用多，TCD、頸彩已經(jīng)開始應(yīng)用于臨床篩查。7、作為確診的影像學(xué)檢查，CTA28.3%、DSA40.6%、DSA聯(lián)合CTA14.6%。以上數(shù)據(jù)可知，CTA、DSA、DSA聯(lián)合CTA，作為確診檢查在臨床中應(yīng)用多，CTA診斷煙霧病比例顯著高于其他檢查（除DSA外）。8、內(nèi)科治療患者84.4%，外科治療患者15.6%，患者以內(nèi)科治療為主。9、內(nèi)科治療緩解84.9%，未緩解15.1%；外科治療緩解87.9%，未緩解12.1%�？偩徑�85.4%。本組研究表明，外科治療緩解率較高。內(nèi)科治療、外科治療效果統(tǒng)計(jì)學(xué)上差異無顯著性。10、兒童患者共12例，缺血型7例，出血型5例。缺血型內(nèi)科治療7例，均緩解。出血型內(nèi)科治療3例，1例緩解，占33.3%，2例未緩解，占66.7%；外科治療2例，均緩解。本研究提示兒童缺血型患者內(nèi)科治療效果顯著，兒童出血型患者外科治療效果顯著。11、青年患者共75例，缺血型33例，出血型42例。缺血型內(nèi)科治療32例，均緩解；外科治療1例，緩解。出血型內(nèi)科治療42例，31例緩解，占73.8%，11例未緩解，占26.2%；外科治療0例。本研究提示青年缺血型患者內(nèi)科治療效果顯著，青年出血型患者內(nèi)科治療有一定風(fēng)險(xiǎn)。12、中老年患者共125例，缺血型50例，出血型75例。缺血型內(nèi)科治療41例，37例緩解，占90.2%，4例未緩解，占9.8%；外科治療9例，均緩解。本研究提示中老年缺血型患者內(nèi)科、外科治療均有顯著效果。出血型內(nèi)科治療54例，44例緩解，占81.5%，10例未緩解，占18.5%；外科治療21例，17例緩解，占81.0%，4例未緩解，占19.0%。經(jīng)統(tǒng)計(jì)學(xué)分析，中老年出血型患者內(nèi)科、外科治療效果差異無顯著性。本研究提示中老年出血型患者內(nèi)科、外科治療均有一定風(fēng)險(xiǎn)。13、兒童，間接手術(shù)1人，直接聯(lián)合間接手術(shù)1人。青年，直接+間接手術(shù)1人。中老年：間接手術(shù)14人，直接+間接手術(shù)3人，動(dòng)脈瘤夾閉+間接手術(shù)7人，動(dòng)脈瘤栓塞/夾閉6人。間接手術(shù)占45.4%，直接+間接手術(shù)占15.2%，動(dòng)脈瘤夾閉+間接手術(shù)21.2%，動(dòng)脈瘤栓塞/夾閉18.2%。本組研究表明，間接搭橋術(shù)、聯(lián)合手術(shù)臨床應(yīng)用多。 結(jié)論：1、煙霧病好發(fā)于45~60歲，無顯著的性別差異。2、高血壓病病史、接種史、吸煙史、飲酒史是煙霧病的可疑危險(xiǎn)因素。3、缺血型煙霧病、出血型煙霧病在不同年齡中無顯著性的分布差異。4、CT、CT聯(lián)合CTA、CT聯(lián)合TCD、MRA、MRA聯(lián)合TCD，作為初次篩選檢查在臨床中應(yīng)用多，TCD、頸彩已經(jīng)開始應(yīng)用于臨床篩查。5、CTA診斷煙霧病特異性強(qiáng)。6、煙霧病目前仍以內(nèi)科治療為主。內(nèi)科治療、外科治療效果差異無顯著性。內(nèi)科治療、外科治療均有顯著緩解率。間接搭橋術(shù)及聯(lián)合手術(shù)可以應(yīng)用于各個(gè)年齡煙霧病患者。
[Abstract]:Moyamoya disease, also known as the abnormal vessel network of the head of the brain, is one of the two-sided internal carotid artery (ICA) siphonage part and the anterior part of the brain, and the starting part of the central artery is very narrow or occluded, the base of the skull base is soft, A chronic cerebral vascular occlusive disease characterized by small blood vessel decompensation such as through-artery and the like. The clear cause of the smoke is not clear. The incidence, the type of the disease and the age of the disease are all the characteristics. Digital subtraction angiography (DSA) is a gold standard for diagnosis of this disease. Magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), computed tomography, CTA and the like have high sensitivity and specificity to the diagnosis of this disease. Appropriate internal surgical treatment is taken according to the disease characteristics of different patients. Methods: A retrospective study of 212 patients with smoke from January 2009 to December 2013 was carried out. A retrospective study of the clinical data related to it, including the time of admission, age, sex, ethnicity, type of onset, body, past medical history, family history, risk factors, laboratory and ultrasound imaging, treatment, and discharge The study data is analyzed using the SPSS17.0 statistical software, and the count data is verified by the Sup2. The p-value is 0.05 or 0.00 according to the case. 1. Results:1. According to the age division of the world health organization (WHO), 5.7% of the children, 35.4% of the youth, and 59 of the middle-aged and the elderly .0%. The number of middle-aged and old-aged patients is significantly higher than that of children and young people the number of patients. The number of patients with 45 to 60 years is more and more concentrated.2. 49.5% of the male patients,50 in the female .5%. The ratio of male to female is close to 1:1, and the overall sex ratio of the patient is not clear. Significant difference. Children's group, male 41.7%, female 58.3%; youth group, male 45.3%, female 54.7%; middle-aged and old-age group, male 52.8%, female 47 2%. There was no significant difference in the gender difference between the children's group, the young group and the middle-and-old-age group.3. The history of hypertension was 25.5%, the history of inoculation was 89.6%, the history of smoking was 35.8%, the history of drinking was 22.6%, and the history of smoking was 17. 9%. The history of hypertension, the history of vaccination, the history of smoking, and the history of drinking were the suspect risk factors of the disease.4. The group of children, 58.3% of the ischemic type, 41.7% of the blood group, 44.0% of the youth group, 44.0% of the ischemic type, 56.0% of the blood group, and 40 in the middle-aged and the elderly. .0%, blood type 60 .0%. According to the age group, there were no differences in the type of incidence among the three groups, and there was no difference in the type of the patients in the children's group, the young group and the middle-and-old-age group. There was no significant difference in the distribution of blood group among children, young people and middle-aged and old-aged and middle-aged and middle-aged and middle-aged and middle-aged patients. The CT combined with the CT and the CT combined with the transcranial Doppler (TCD) was 12.7%, the combination of the MRA and the MRA was 11.8% and the TCD combined with the neck-color 2. 8%. The above data shows that CT, CT, CTA, CT, TCD, MRA and MRA are combined with TCD. As a primary screening test, TCD and MRA have been applied to clinical screening.7. As a confirmed image, CTA2.8.3%, DSA40.6%, DSA and CTA14 It was found that CTA, DSA and DSA combined with CTA in the clinical application of CTA, DSA and DSA. The proportion of CTA in the diagnosis of smoke was significantly higher than that of other examinations (except for DSA).8. The patients with internal medicine were 84.4% and 15.6% of the patients with surgical treatment, and the patients were treated with internal medicine. The main.9, the medical treatment was relieved by 84.9%, with no relief of 15.1%; the surgical treatment was relieved by 87.9%, and the result was not relieved .1%. Total Response 85 .4%. The results of this study show that the surgical treatment is relieved The rate was high. There was no significant difference in the treatment of internal medicine and the effect of surgical treatment. There were 12 cases of children,7 cases of ischemic type, and hemorrhage. 5 cases of ischemic type,7 cases of ischemic internal medicine, All of them were relieved.3 cases were treated with blood group internal medicine,1 case was alleviated, 33.3% and 2 cases were not relieved, accounting for 66.7%, and the surgical treatment was 2 cases. The results showed that the treatment effect of the internal medicine of the children with ischemic type was remarkable, the surgical treatment effect of the children with blood group was remarkable.11,75 cases of the young patients,33 cases of the ischemic type, and the blood type 42 cases:32 cases of ischemic internal medicine and 1 case of surgical treatment In the treatment of 42 cases of blood group internal medicine,31 cases were relieved, 73.8% and 11 cases were not relieved, accounting for 26.2%, and the surgical treatment The results of this study indicated that the treatment effect of the internal medicine of the young ischemic type was significant, and there was a certain risk in the treatment of the patients with blood group. Of the 75 cases,41 cases were treated with ischemic internal medicine,37 cases were alleviated, 90.2% and 4 cases were not relieved, accounting for 9.8%, and the surgical treatment was 9 cases. The study indicated that the internal medicine and surgical treatment of the middle-and-old-aged and middle-aged and old-aged patients had significant effects. The results showed that 54 cases of blood group internal medicine were treated,44 cases were relieved, 81.5% and 10 cases were not relieved, accounting for 18.5%, the surgical treatment was 21 cases,17 cases were relieved, 81.0% and 4 cases were not relieved, accounting for 19%. In that middle-and-old-aged and old-age group, there was no difference in the effect of surgical treatment. The results showed that the internal medicine and surgical treatment of the middle-and-old-aged and old-aged patients had a certain risk.13. The indirect operation of the children and the indirect operation was directly combined with the indirect hand. 1 person. Young, direct + indirect. 1 person in the middle and old age:14 indirect operation,3 direct + indirect operation,7 aneurysm clipping + indirect operation, and aneurysm embolization/ clamp Closed 6 persons, indirect operation 45.4%, direct + indirect operation 15.2%, aneurysm clipping + indirect operation 21.2%, aneurysm embolization/ clipping 18 2%. The results of this study show that the indirect bridge operation and the combined operation are clinical. Conclusion:1. There is no significant difference in sex difference between 45 and 60 years. The history of hypertension, the history of inoculation, the history of smoking, and the history of alcohol consumption are the suspect risk factors of the smoke.3. There is no significant difference in the distribution of blood type and smoke in different ages. .4, CT, CT, CTA, CT, TCD, MRA and MRA combined with TCD. As a primary screening test, TCD and MRA were used in clinical screening. The treatment of medical treatment and surgical treatment is poor. There is no significant difference in medical treatment and surgical treatment. Significant remission rates. Indirect bridging and joint procedures can be applied to all ages
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

【共引文獻(xiàn)】

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