本文選題：煙霧病 + 外科血管重建　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的對(duì)比分析顳淺動(dòng)脈-大腦中動(dòng)脈搭橋聯(lián)合顳淺動(dòng)脈分支貼敷術(shù)與腦-硬膜-顳肌血管貼敷術(shù)治療成人煙霧病的安全性及療效,探討成人煙霧病外科治療的最佳手術(shù)方式。方法回顧性分析2011年8月至2016年5月在鄭州大學(xué)第一附屬醫(yī)院神經(jīng)外科接受外科血管重建術(shù)治療(單側(cè)半球)的118例成人煙霧病患者的完整臨床資料,其中采用顳淺動(dòng)脈-大腦中動(dòng)脈(superficial temporal artery-middle cerebral artery,STA-MCA)搭橋聯(lián)合顳淺動(dòng)脈分支貼敷術(shù)(combiend bypass surgery,CBS)51例(CBS組),采用腦-硬膜-顳肌血管貼敷術(shù)(Encephalo-duro-myo-synangiosis,EDMS)67例(EDMS組),比較兩組患者術(shù)后并發(fā)癥發(fā)生率,近期(術(shù)后3月)癥狀緩解率、CTP血流動(dòng)力學(xué)參數(shù)變化率,遠(yuǎn)期(≥術(shù)后3月)癥狀緩解率、再出血發(fā)生率、再缺血發(fā)生率、血管重建率以及腦血流動(dòng)力學(xué)參數(shù)變化率,隨訪時(shí)間為3月~67月,平均(22.3±2.1)月。定量資料組間比較采用t檢驗(yàn)或校正的t檢驗(yàn)、配對(duì)t檢驗(yàn)或非參數(shù)配對(duì)wilcoxon檢驗(yàn),定性資料組間比較采用χ~2檢驗(yàn)、Kruskal-Wallis秩和檢驗(yàn)或χ~2檢驗(yàn)連續(xù)校正(Yates校正),P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.CBS組術(shù)后并發(fā)癥發(fā)生率(33.3%,17/51)高于EDMS組(13.4%,9/67),主要表現(xiàn)為高灌注綜合征(CHS),差異有統(tǒng)計(jì)學(xué)意義(χ~2=6.676,P0.05);2.術(shù)后近期CBS組癥狀緩解率(86.3%)高于EDMS組(40.3%),差異有統(tǒng)計(jì)學(xué)意義(H=31.199,P0.05);3.CTP相關(guān)參數(shù)變化:CBS組術(shù)后短期內(nèi)CBF、r CBF較術(shù)前增加,TTP及r TTP較術(shù)前縮短,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),CBV、r CBV較術(shù)前減少,差異無統(tǒng)計(jì)學(xué)意義(P0.05);EDMS組術(shù)后短期內(nèi)CBF、r CBF較術(shù)前增加,CBV、r CBV較術(shù)前減少,差異均無統(tǒng)計(jì)學(xué)意義(P0.05),TTP及r TTP較術(shù)前縮短,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后早期,CBS組與EDMS組相比CBF、r CBF增加更為明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后遠(yuǎn)期,CBS組平均CBF高于EDMS組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);4.術(shù)后遠(yuǎn)期CBS組術(shù)前癥狀緩解率(92.2%)高于EDMS組(79.1%),差異有統(tǒng)計(jì)學(xué)意義(H=5.783,P0.05);5.CBS組總體術(shù)后遠(yuǎn)期出血率(5.9%)低于EDMS組(9.0%),差異無統(tǒng)計(jì)學(xué)意義(χ~2=0.074,P0.05);CBS組中出血型MMD再出血率(6.7%)低于EDMS組中出血型MMD再出血率(12.2%),差異無統(tǒng)計(jì)學(xué)意義(χ~2=0.136,P0.05);6.CBS組中缺血型MMD再缺血率(4.8%)低于EDMS組中缺血型MMD再缺血率(11.5%)差異無統(tǒng)計(jì)學(xué)意義(χ~2=0.091,P0.05);7.CBS組術(shù)后血管重建有效率(92.2%)高于EDMS組(61.2%),差異有統(tǒng)計(jì)學(xué)意義(H=20.705,P0.05);8.CBS組中3例未處理的周圍型動(dòng)脈瘤,2例消失、1例較術(shù)前縮小;EDMS組中2例未處理的周圍型動(dòng)脈瘤,復(fù)查DSA發(fā)現(xiàn)全部消失。研究結(jié)論1.顳淺動(dòng)脈-大腦中動(dòng)脈搭橋聯(lián)合顳淺動(dòng)脈分支貼敷術(shù)(CBS)與腦-硬膜-顳肌血管貼敷術(shù)(EDMS)均是治療成人缺血型煙霧病的有效手術(shù)方式;2.顳淺動(dòng)脈-大腦中動(dòng)脈搭橋聯(lián)合顳淺動(dòng)脈分支貼敷術(shù)(CBS)治療成人缺血型煙霧病的效果更為確切,具有癥狀緩解迅速及緩解率高、腦灌注改善明顯、血管重建有效率高的優(yōu)勢(shì);3.治療出血型煙霧病尚不能確定哪種術(shù)式更為有效,顳淺動(dòng)脈-大腦中動(dòng)脈搭橋聯(lián)合顳淺動(dòng)脈分支貼敷術(shù)(CBS)可能對(duì)出血型煙霧病患者有益,有待進(jìn)一步研究。4.CBS組術(shù)后并發(fā)癥發(fā)生率高于EDMS組,高灌注綜合征是CBS術(shù)后最常見并發(fā)癥。
[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.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.12

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2 左智煒;煙霧病患者皮層厚度及血流動(dòng)力學(xué)反應(yīng)研究[D];中國(guó)人民解放軍軍事醫(yī)學(xué)科學(xué)院;2015年

3 劉錫禹;煙霧病合并后循環(huán)病變致枕葉梗死的相關(guān)危險(xiǎn)因素分析[D];中國(guó)人民解放軍軍事醫(yī)學(xué)科學(xué)院;2015年

4 葉挺;煙霧綜合征臨床特征及外科手術(shù)療效[D];中國(guó)人民解放軍軍事醫(yī)學(xué)科學(xué)院;2015年

5 楊懷滔;合并顱內(nèi)動(dòng)脈瘤的煙霧病：臨床特征、出血危險(xiǎn)因素和治療轉(zhuǎn)歸[D];安徽醫(yī)科大學(xué);2015年

6 張登文;腦—顳淺動(dòng)脈—顳淺筋膜貼敷術(shù)治療煙霧病療效研究[D];第四軍醫(yī)大學(xué);2015年

7 王筱萌;中國(guó)漢族成年型煙霧病患者基因多態(tài)性與基因—基因交互作用研究[D];南京大學(xué);2013年

8 王斌;煙霧病責(zé)任血管、術(shù)后重建血管及手術(shù)前后腦血流動(dòng)力學(xué)變化的MR研究[D];復(fù)旦大學(xué);2014年

9 張曉斌;自發(fā)性腦室出血與煙霧病合并動(dòng)脈瘤的診斷及治療策略[D];南方醫(yī)科大學(xué);2015年

10 韋維;成人煙霧病患者腦缺血、腦出血事件發(fā)生與Suzuki分級(jí)的關(guān)系[D];廣西醫(yī)科大學(xué);2015年

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