摘要
目的评价颞浅动脉(STA)和脑血管的吻合技术——序贯双吻合(SDA)技术(单支STA和2支脑血管序贯吻合的技术)治疗烟雾病(MMD)的可行性、安全性和短期疗效。方法回顾性分析2019年7月至2020年4月中国医科大学附属第一医院收治的采用SDA技术治疗的4例MMD患者,共行5次SDA和颞肌脑贴敷术(1例患者两侧手术间隔2个月)。采用翼点入路,皮下游离STA,测量STA的切割流量(CF);将STA的额支或顶支的中段和大脑中动脉M4侧侧吻合,然后将该STA末端和大脑中动脉M4或大脑前动脉A5端侧吻合;将颞肌和硬脑膜缝合贴敷在脑组织表面;还纳骨瓣,逐层关颅。术后1周采用超声测量STA血流量;术后1周及术后4~6个月采用数字减影血管造影(DSA)和(或)CT血管造影(CTA)评估STA和脑血管吻合口的通畅性;记录患者住院和随访期间脑卒中并发症和其他临床表现。结果3例患者4次手术均单纯采用SDA技术,余1例患者追加STA顶支-M4端侧吻合。术中STA的CF为15.0~36.0 ml/min,平均(23.6±7.7)ml/min,术后1周为40.0~125.0 ml/min,平均(96.8±31.2)ml/min。术后最后一次DSA和(或)CTA检查时间为术后1~24周,平均(15.4±7.8)周,11个吻合口中10个吻合口通畅,1个SDA的STA-A5端侧吻合口闭塞。5例SDA 10个吻合口的短期通畅率为90.0%(9/10)。5例患者术后临床随访时间为3~12个月,平均(7.4±3.0)个月。4例患者术后及随访期间未发生脑卒中事件、脑过度灌注和其他并发症。结论SDA技术可以安全地应用于脑缺血起病的MMD治疗中,术后短期疗效理想。
Objective To evaluate the short-term outcomes of patients with moyamoya disease(MMD)who underwent a novel direct bypass technique-superficial temporal artery(STA)to cerebrovascular sequential double anastomosis(SDA)(single STA and two cerebrovascular sequential anastomosis technique).Methods Clinical data of patients with MMD who underwent SDA from July 2019 to April 2020 in the First Hospital of China Medical University was retrospectively analyzed.Intraoperative cut flow(CF)of STA was recorded.A double anastomosis using a single STA donor branch for both a proximal STA to M4 side to side anastomosis and a distal STA to M4 or A5 end to side anastomosis were performed.STA flow was measured ultrasonically one week after surgery.Bypass patency was assessed by cerebral digital subtraction angiography(DSA)and/or computed tomography angiography(CTA)both one week and 4-6 months after surgery.Adverse events occurring during the hospital stay and clinical status at last follow up were recorded.Results Three MMD patients underwent four simple SDA operations.The other patient underwent SDA plus STA parietal-M4 anastomosis.The mean CF in STA was(23.6±7.7)ml/min(15-36 ml/min),and was(96.8±31.2)ml/min(40-125 ml/min)at one week after the operation.The mean follow-up duration of DSA and/or CTA was(15.4±7.8)weeks(1-24 weeks).Nine bypasses(90.0%)were unobstructed postoperatively and remained unobstructed at last follow up.The mean follow-up was(7.4±3.0)months.None of patients had a new-onset stroke or cerebral hyperperfusion syndrome.Conclusion SDA technique can be safely used in the treatment of ischemic MMD,and short-term postoperative outcomes were good.
作者
佟志勇
孙怀宇
刘源
王刚
张劲松
初金刚
温志锋
潘起晨
梁传声
Tong Zhiyong;Sun Huaiyu;Liu Yuan;Wang Gang;Zhang Jinsong;Chu Jingang;Wen Zhifeng;Pan Qichen;Liang Chuansheng(Department of Neurosurgery,the First Hospital of China Medical University,Shenyang 110001,China;Department of Neurosurgery,Tiemei General Hospital of Liaoning Province Health Industry Group of Shenyang Medical College,Tieling 112700,China;Department of Cardiovascular Ultrasound,the First Hospital of China Medical University,Shenyang 110001,China;Department of Radiology,the First Hospital of China Medical University,Shenyang 110001,China)
出处
《中华脑血管病杂志（电子版）》
2021年第2期88-94,共7页
Chinese Journal of Cerebrovascular Diseases(Electronic Edition)
基金
2019沈阳市科技计划项目人口与健康专项(19-112-4-062)。
关键词
烟雾病
颞浅动脉
脑血管
序贯双吻合技术
Moyamoya disease
Superficial temporal artery
Cerebrovascular
Sequential double anastomosis
