本文選題：煙霧病 + 出血　； 參考：《中國人民解放軍軍事醫(yī)學(xué)科學(xué)院》2015年碩士論文

【摘要】：目的本研究對出血型煙霧病累及大腦后循環(huán)病變患者的一般資料、臨床及影像資料進(jìn)行回顧性分析,進(jìn)而探討出血型煙霧病累及后循環(huán)病變患者的臨床及影像學(xué)特征;并對患者進(jìn)行術(shù)后隨訪,評估其手術(shù)效果。方法回顧性分析2002年12月—2011年12月期間軍事醫(yī)學(xué)科學(xué)院附屬醫(yī)院收治的煙霧病患者,并根據(jù)患者的頭顱CT及頭顱MRI,從中篩選出血型患者224例,對224例患者DSA影像資料進(jìn)行判讀,獲得后循環(huán)受累的患者57例,未受累患者167例。對受累組與未受累組的年齡、性別、成人比、出血類型、前循環(huán)的鈴木分期、出血側(cè)異常血管擴(kuò)張情況進(jìn)行統(tǒng)計學(xué)分析;并對患者進(jìn)行電話或信件隨訪,對其中40例行雙側(cè)EDAS術(shù)患者的手術(shù)前后的m RS評分進(jìn)行統(tǒng)計學(xué)分析。結(jié)果1.224例煙霧病患者占同期收治的煙霧病患者的14.24%,其中101例患者為男性,123例患者為女性,其比例為1:1.22,患者入院時的年齡為1-57歲。并獲得57例(25.45%)累及后循環(huán)病變,其中21例患者為男性,36例患者為女性,其比例1:1.71,患者入院年齡為13—56歲,其中54例(94.74%)患者為成人。167例(75.55%)后循環(huán)未受累,其中80例患者為男性,67例患者為女性,其比例為1:1.0875,患者入院年齡為1-57歲,其中156例(93.41%)患者為成人。后循環(huán)受累組與未受累組在性別比(P0.05)、成人比(P0.05)年齡(P0.05)分布方面均無明顯差異。2.本組224例煙霧病患者中,腦室出血85例;蛛網(wǎng)膜下腔出血34例;腦實(shí)質(zhì)出血105例(丘腦出血25例,基底節(jié)出血44例,腦葉出血36例)。其中后循環(huán)受累組患者中腦葉出血0例,丘腦出血25例,基底節(jié)出血2例,腦室出血22例,蛛網(wǎng)膜下腔出血8例;后循環(huán)未受累組患者中腦葉出血36例,丘腦出血0例,基底節(jié)出血42例,腦室出血63例,蛛網(wǎng)膜下腔出血26例。其中29例(50.9%)表現(xiàn)為單側(cè)大腦后動脈受累,出血類型分別為蛛網(wǎng)膜下腔出血3例(10.3%,1例對側(cè)出血),丘腦出血14例(48.3%,無對側(cè)出血),腦室出血12例(41.4%,3例對側(cè)出血)。后循環(huán)受累組患者的出血類型多為丘腦出血(43.86%)及腦室出血(38.60%)且丘腦出血與后循環(huán)受累具有統(tǒng)計學(xué)差異(P0.01);3.對224例出血型煙霧病患者的頸內(nèi)動脈鈴木分期統(tǒng)計,57例后循環(huán)受累組頸內(nèi)動脈鈴木分期為:3期3例,4期7例,5期24例,6期23例;后循環(huán)受累組的患者的鈴木分期多集中在5(42.1%)、6(40.4%)期;167例后循環(huán)未受累組頸內(nèi)動脈鈴木分期為:2期30例,3期52例,4期70例,5期7例,6期8例;后循環(huán)未受累組患者的鈴木分期處于3(31.1%)、4(41.9%)期的較多,并使用等級資料兩樣本比較的Wilcoxon秩和檢驗(yàn)統(tǒng)計分析,后循環(huán)是否受累在鈴木分期分布方面具有統(tǒng)計學(xué)差異(P0.01);4.對57例出血型煙霧病累及后循環(huán)病變患者的大腦后循環(huán)分期進(jìn)行統(tǒng)計,后循環(huán)受累組后循環(huán)病變分期左側(cè)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%);右側(cè)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%)。對每名患者的大腦前后循環(huán)左右側(cè)病變程度進(jìn)行對比,發(fā)現(xiàn)24例患者中的前后循環(huán)病變出現(xiàn)偏側(cè)性。在這24例患者中,有20例(83.33%)患者出現(xiàn)前后循環(huán)病變在同一側(cè),但是有4例(16.67%)患者前后循環(huán)病變出現(xiàn)在對側(cè),并根據(jù)頸內(nèi)動脈鈴木分期及大腦后動脈分期左右嚴(yán)重程度進(jìn)行分組,顯示出57例患者的前后循環(huán)病變的偏側(cè)性關(guān)系。顯示這前后循環(huán)病變在統(tǒng)計學(xué)分析中有很大可能會出現(xiàn)在同一側(cè),及左右側(cè)的一致性并具有差異性(P0.01);5.57例出血型煙霧病后循環(huán)受累組患者中,出血同側(cè)表現(xiàn)了脈絡(luò)膜前動脈擴(kuò)張的患者11例,后交通動脈開放的患者21例,脈絡(luò)膜后動脈擴(kuò)張的患者47例,后胼周動脈開放的患者45例;167例出血型煙霧病后循環(huán)未受累患者中,出血同側(cè)表現(xiàn)了脈絡(luò)膜前動脈的擴(kuò)張的患者61例,出血同側(cè)后交通動脈開放的患者115例,脈絡(luò)膜后動脈擴(kuò)張的患者5例,后胼周動脈開放的患者134例,異常血管擴(kuò)張或開放情況與后循環(huán)是否受累具有一定的相關(guān)性(P0.05),并發(fā)現(xiàn)后循環(huán)受累組患者的出血同側(cè)多表現(xiàn)出脈絡(luò)膜后動脈擴(kuò)張、后胼周動脈開放。發(fā)現(xiàn)后循環(huán)受累情況與同側(cè)后胼周動脈開放情況無相關(guān)性(P=0.833),后循環(huán)受累情況多與同側(cè)脈絡(luò)膜后動脈擴(kuò)張情況具有相關(guān)性(P0.01),后循環(huán)受累的患者較少出現(xiàn)后交通動脈開放(P0.01);6.57例后循環(huán)病變的患者中,1人右側(cè)STA-MCA術(shù),左側(cè)EDAS術(shù),并行枕部貼敷術(shù);41人行雙側(cè)EDAS術(shù);9人行雙側(cè)EDAS術(shù)+枕部血管貼敷術(shù);4例行單側(cè)EDAS術(shù);2例未行手術(shù)。7.57例患者進(jìn)行術(shù)后電話或信件隨訪,平均隨訪時間35.8月(8-102月),其中失訪4例,2例未行手術(shù),1例僅行單側(cè)EDSA術(shù),1例行雙側(cè)EDSA術(shù)。對40例雙側(cè)EDAS術(shù)患者的手術(shù)前后m RS評分,術(shù)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,術(shù)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。患者術(shù)后m RS評分明顯低于術(shù)前m RS評分(P=0.01),有2例(5%)患者術(shù)后出現(xiàn)再出血。結(jié)論后循環(huán)受累的出血型煙霧病并不少見,且以成人女性較為多見;煙霧病累及后循環(huán)病變的患者前循環(huán)鈴木分期多為晚期,且后循環(huán)病變具有偏側(cè)性,即前后循環(huán)病變嚴(yán)重程度具有一定的一致性,煙霧病的病情發(fā)展,同側(cè)會出現(xiàn)后循環(huán)病變;累及后循環(huán)病變的出血類型多為丘腦出血和腦室出血;累及后循環(huán)病變的患者出血原因可能與脈絡(luò)膜后動脈擴(kuò)張有關(guān);該組出血型煙霧病累及后循環(huán)病變患者經(jīng)EDAS術(shù)治療,臨床癥狀改善顯著,再出血率較低。
[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.
【學(xué)位授予單位】：中國人民解放軍軍事醫(yī)學(xué)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.12
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本文編號：1987435