本文選題：血運重建術(shù) + 顱內(nèi)外血管搭橋　； 參考：《山東大學(xué)》2016年碩士論文

【摘要】：背景：目前對于煙霧病患者,保守治療療效不佳,治療主要依賴于腦血運重建術(shù)。對于粥樣硬化性頸動脈狹窄/閉塞的患者首選藥物治療,但部分患者最佳藥物治療后仍有頻繁缺血發(fā)作,這部分患者可從腦血運重建術(shù)中獲益。另外,對于顱內(nèi)復(fù)雜動脈瘤等腦出血性疾病,雖然近年來顯微神經(jīng)外科和神經(jīng)介入技術(shù)飛速發(fā)展,但仍有部分復(fù)雜動脈瘤患者無法通過手術(shù)夾閉或介入栓塞的方式得到治療,腦血運重建術(shù)在這部分患者的治療中也扮演著不可替代的作用。目的：探討不同術(shù)式的腦血運重建術(shù)在煙霧病、慢性癥狀性ICA/MCA閉塞、顱內(nèi)復(fù)雜動脈瘤的患者中的臨床應(yīng)用價值。方法：回顧性分析2013年7月至2016年2月至山東大學(xué)齊魯醫(yī)院神經(jīng)外科就診的99例行腦血運重建術(shù)的患者資料。其中煙霧病患者70例,給予癥狀側(cè)STA-MCA搭橋術(shù)聯(lián)合腦-硬腦膜-肌肉-血管融合術(shù)(EDMS);慢性癥狀性ICA/MCA閉塞患者17例,給予STA-MCA搭橋術(shù)；顱內(nèi)復(fù)雜動脈瘤患者12例,根據(jù)不同動脈瘤特點分別給予個體化的血運重建術(shù)。并對所有患者的病例特點、治療方法、圍術(shù)期并發(fā)癥進行了統(tǒng)計分析。另外,有48例慢性腦缺血的患者(36例煙霧病患者、12例慢性癥狀性ICA/MCA閉塞患者)和11例顱內(nèi)復(fù)雜動脈瘤患者完成了中期隨訪,對隨訪患者的吻合血管通暢性、腦血流動力學(xué)改變、患者神經(jīng)功能改變及動脈瘤改變情況進行了統(tǒng)計分析。結(jié)果：1、煙霧病和慢性癥狀性ICA/MCA閉塞：①術(shù)后6-12個月隨訪DSA提示44例／48例(92%)患者吻合血管通暢。其中煙霧病患者22例／36例(61%)顳肌下有不同程度的新生血管網(wǎng)形成并向皮層供血。②40例／48例(83%)患者CTP檢查與術(shù)前相比rCBF得到改善,6例／48例(13%)rCBF不變,2例/48例(4%)rCBF惡化。③45例/48例(94%)未再發(fā)生與吻合側(cè)半球相關(guān)的腦缺血或腦出血發(fā)作。20例/48例(42%)患者的mRs評分較術(shù)前降低,25例/48例(52%)患者的mRs評分與術(shù)前一樣(包括12例0分的患者),3例/48例(6%)患者術(shù)后mRs評分較術(shù)前升高。④87例慢性腦缺血的患者中9例(10.3%)出現(xiàn)了不同形式的圍術(shù)期并發(fā)癥。2、復(fù)雜動脈瘤：①術(shù)后3-6個月隨訪DSA/CTA示10例/11例(91%)吻合血管通暢性良好。② DSA/CTA示所有(100%)隨訪的復(fù)雜動脈瘤均無復(fù)發(fā)和殘留。③所有隨訪患者(100%)術(shù)后3-6個月內(nèi)無新發(fā)神經(jīng)功能損害的癥狀和體征。7例患者mRs評分下降,2例保持不變,2例由于圍術(shù)期并發(fā)癥mRs評分升高。④12例復(fù)雜動脈瘤患者中3例(25%)發(fā)生了圍術(shù)期并發(fā)癥。結(jié)論：1、STA-MCA搭橋+EDMS對成人煙霧病患者有良好的療效,可改善其腦灌注和神經(jīng)功能,預(yù)防卒中事件再發(fā)生。2、在伴有血流動力學(xué)障礙的慢性癥狀性ICA/MCA閉塞患者中,STA-MCA搭橋術(shù)可改善其腦灌注和神經(jīng)功能,降低其潛在的卒中發(fā)生率。3、根據(jù)復(fù)雜動脈瘤的位置、形態(tài)、大小等特點進行個體化的血運重建術(shù)是一種治療復(fù)雜動脈瘤的有效方法。
[Abstract]:Background: for moyamoya disease patients, conservative treatment is not good, the treatment mainly depends on cerebral revascularization. For patients with atherosclerotic carotid artery stenosis / occlusion, the first choice of drug treatment, but some patients still have frequent ischemic attacks after the best drug treatment, this part of patients can benefit from cerebral blood revascularization. In addition, although microneurosurgery and neurointerventional techniques have developed rapidly in recent years, some complicated aneurysms can not be treated by surgical clipping or interventional embolization. Cerebral revascularization also plays an irreplaceable role in the treatment of these patients. Objective: to evaluate the clinical value of different types of cerebral revascularization in patients with moyamoya disease, chronic symptomatic ICA / MCA occlusion and complicated intracranial aneurysms. Methods: from July 2013 to February 2016, the data of 99 patients undergoing cerebral revascularization in Qilu Hospital of Shandong University were analyzed retrospectively. Seventy patients with moyamoya disease were treated with symptomatic STA-MCA bypass grafting combined with brain-dural musculovascular fusion (EDMS), 17 patients with chronic symptomatic ICA / MCA occlusion and 12 patients with complicated intracranial aneurysms. Individual revascularization was performed according to the characteristics of different aneurysms. The characteristics, treatment methods and perioperative complications of all patients were analyzed statistically. In addition, 48 patients with chronic cerebral ischemia (36 patients with moyamoya disease and 12 patients with chronic symptomatic ICA / MCA occlusion) and 11 patients with complex intracranial aneurysms completed a mid-term follow-up. The changes of nerve function and aneurysm were analyzed statistically. Results after 6 to 12 months follow-up DSA showed that 44 / 48 (92%) patients with moyamoya disease and chronic symptomatic ICA / MCA / MCA: 1 had patency. Among them, 22 / 36 (61%) patients with moyamoya disease had varying degrees of neovascularization in the subtemporal muscle, and 240 / 48 (83%) patients had cortical blood supply. The CTP examination of patients with moyamoya disease was improved in 6 cases, 48 cases (13%) in 6 cases (13%), 2% in 48 cases. (4%) .345 cases of rCBF deterioration. 48 cases (94%) had no recurrence of cerebral ischemia or cerebral hemorrhage associated with anastomosing side hemispheres. 20 / 48 (42%) patients had the same MRS score as before operation (including 12 cases 0%), 25 cases / 48 cases (52%) had the same MRS score as before operation (including 12 cases 0%). MRS scores of 3 / 48 (6%) patients were higher than those before operation. Of the 487 patients with chronic cerebral ischemia, 9 (10.3%) had different forms of perioperative complications. 10 patients with complex aneurysms were followed up 3-6 months after operation with DSA-CTA. 11 cases (91%) with good vascular anastomosis. 2 DSA / CTA showed no recurrence of all (100%) complicated aneurysms and 3% (100%) all patients followed up without symptoms and signs of new neurological impairment within 3 to 6 months after operation. The score decreased in 2 cases and remained unchanged in 2 cases. Among 412 patients with complex aneurysms, 3 cases (25%) developed perioperative complications due to increased score of mRS in perioperative complications. Conclusion the EDMS graft with 1: 1 + STA-MCA has a good curative effect on adult moyamoya disease patients, and can improve the cerebral perfusion and nerve function of adult moyamoya disease patients. In patients with chronic symptomatic ICA / MCA occlusion with hemodynamic disorders, STA-MCA bypass grafting can improve cerebral perfusion and neurological function, and reduce the potential incidence of stroke by 0.3, depending on the location and shape of complex aneurysms. Individualized revascularization is an effective method for the treatment of complex aneurysms.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R651.12

【相似文獻】

相關(guān)期刊論文 前10條

1 仝其廣;胡大一;王錦紋;史旭波;肖潔;鄭華;馬志敏;;冠脈血運重建術(shù)后長期治療調(diào)查[J];中國醫(yī)藥導(dǎo)刊;2010年05期

2 CQS;心臟血運重建術(shù)使用率的種族差異[J];中華醫(yī)學(xué)信息導(dǎo)報;2001年22期

3 方玉強;楊成明;;噻唑烷二酮類藥物可能減少支架內(nèi)再狹窄和血運重建術(shù)[J];中國介入心臟病學(xué)雜志;2008年02期

4 王艷紅;欒獻亭;世慧娜;;血運重建術(shù)治療冠心病合并心力衰竭[J];現(xiàn)代預(yù)防醫(yī)學(xué);2008年14期

5 王培寧,汪師貞,楊新春,楊舒玲,汪愛虎,陳明;急性心肌梗死血運重建術(shù)后遠期預(yù)后的相關(guān)因素[J];心臟雜志;2005年04期

6 田軍,楊躍進,王燕武,楊守忠,邢心倫,湯五洲,徐義樞,高潤霖;超聲心動圖評價冠狀動脈血運重建術(shù)對改善陳舊性心肌梗死區(qū)域室壁運動的意義[J];中國實用內(nèi)科雜志;1998年08期

7 劉海波,高潤霖,楊躍進,姚民,徐波,秦學(xué)文,陳紀林,胡盛壽,宋云虎,劉進;聯(lián)合冠狀動脈血運重建術(shù)國內(nèi)首例報告(摘要)[J];中國循環(huán)雜志;1999年S1期

8 劉敏;張?zhí)K川;閆杰;徐亞寧;劉波;鄒勇;余信強;;醫(yī)院與社區(qū)聯(lián)合干預(yù)模式對冠心病患者血運重建術(shù)后預(yù)后的影響[J];臨床心血管病雜志;2013年10期

9 王學(xué)勇;經(jīng)心肌激光打孔血運重建術(shù)與麻醉[J];國外醫(yī)學(xué).麻醉學(xué)與復(fù)蘇分冊;1998年03期

10 梁雨露,施廣飛,王東進,賈朝相,張榮林,王春;聯(lián)合冠狀動脈血運重建術(shù)一例[J];江蘇醫(yī)藥;2001年10期

相關(guān)會議論文 前4條

1 杜昕;馬長生;康俊萍;呂強;聶紹平;高迎春;張];賈長琪;劉新民;賀立群;湯麗川;闕斌;董建增;劉曉惠;;血運重建術(shù)前血糖異常的檢出率及其對預(yù)后的影響[A];中華醫(yī)學(xué)會心血管病學(xué)分會第八次全國心血管病學(xué)術(shù)會議匯編[C];2006年

2 楊興益;康春松;;小劑量多巴酚丁胺負荷超聲心動圖預(yù)測血運重建術(shù)后心功能改善的價值[A];全國醫(yī)學(xué)影像技術(shù)學(xué)術(shù)會議（CMIT-2004）論文匯編[C];2004年

3 袁莉;王新房;呂清;賀林;王靜;;實時三維超聲評價血運重建術(shù)前后冠心病患者的左室收縮功能[A];中華醫(yī)學(xué)會第十次全國超聲醫(yī)學(xué)學(xué)術(shù)會議論文匯編[C];2009年

4 遲騁;任景怡;陳紅;;冠狀動脈CT血管成像在2型糖尿病合并冠心病患者血運重建術(shù)后橋血管及支架評價中的價值[A];第十三次全國心血管病學(xué)術(shù)會議論文集[C];2011年

相關(guān)碩士學(xué)位論文 前5條

1 李麗;牙髓血運重建術(shù)在外傷致年輕恒牙牙髓壞死中的應(yīng)用[D];山西醫(yī)科大學(xué);2016年

2 劉斌;腦血運重建術(shù)在腦血管疾病治療中的臨床應(yīng)用[D];山東大學(xué);2016年

3 譚國娟;多譜勒組織成像（DTI）技術(shù)對血運重建術(shù)心功能評估的臨床研究[D];中國人民解放軍軍醫(yī)進修學(xué)院;2002年

4 申星花;血運重建術(shù)對高齡冠心病患者臨床療效的觀察[D];延邊大學(xué);2007年

5 于志遠;益氣活血解毒法治療冠脈血運重建術(shù)后再發(fā)心絞痛臨床療效觀察[D];山東中醫(yī)藥大學(xué);2014年

，

本文編號：2100921