颞浅动脉-大脑中动脉分流术治疗大脑中动脉狭窄性脑卒中的疗效观察
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摘要
目的探讨颞浅动脉(STA)-大脑中动脉(MCA)分流术治疗大脑中动脉狭窄致缺血性卒中的安全性和有效性。方法回顾性分析2013年1月至2016年12月STA-MCA分流术治疗的75例大脑中动脉狭窄引起的缺血性卒中的临床资料。结果术中B超探查显示71例吻合口血流通畅满意,4例血流缓慢。术后3 d死亡2例,其余73例术后CT灌注成像检查显示脑血流灌注明显改善。术后7、14 d神经功能评分较治疗前明显改善(P<0.05),术后6、12个月神经功能评分进一步好转(P<0.05)。术后随访12个月,73例未出现因搭桥血管狭窄或闭塞引起的新发脑梗死及TIA;67例CTA检查显示血管显影良好。结论 STA-MCA分流术是预防和治疗大脑中动脉狭窄性卒中安全、有效的手段。
Objective To investigate the safety of superficial temporal artery-middle cerebral artery(STA-MCA) bypass and its curative effect on ischemic stroke included by MCA stenosis. Methods The clinical data of 75 patients with ischemic stroke caused by stenosis or occlusion of MCA, who underwent STA-MCA bypass, were analyzed retrospectively. The neuroimaging examinations,modified Ranki scale(mRS) and National Institute of Health stroke sale(NIHSS) were performed before and after the operation. The blood flow of STA-MCA bypass was detected by intraoperative B-ultrasound. The perioperative complications were observed in all the patients. Results The blood vessel of STA-MCA bypass were unobstructed in 71 cases and the blood flow was slow in 4 cases. Two patients died after the operation. The cerebral blood flow and neurological function were significantly improved in the survival 73 patients. All the survival patients were recovered well and no new cerebral infarction and transient ischemia attack symptoms were found in theses 73 patients 12 months after the operation. Conclusion STA-MCA bypass is a safe and effective method to treat the patients with ischemic stroke caused by stenosis of MCA.
Objective To investigate the safety of superficial temporal artery-middle cerebral artery(STA-MCA) bypass and its curative effect on ischemic stroke included by MCA stenosis. Methods The clinical data of 75 patients with ischemic stroke caused by stenosis or occlusion of MCA, who underwent STA-MCA bypass, were analyzed retrospectively. The neuroimaging examinations,modified Ranki scale(mRS) and National Institute of Health stroke sale(NIHSS) were performed before and after the operation. The blood flow of STA-MCA bypass was detected by intraoperative B-ultrasound. The perioperative complications were observed in all the patients. Results The blood vessel of STA-MCA bypass were unobstructed in 71 cases and the blood flow was slow in 4 cases. Two patients died after the operation. The cerebral blood flow and neurological function were significantly improved in the survival 73 patients. All the survival patients were recovered well and no new cerebral infarction and transient ischemia attack symptoms were found in theses 73 patients 12 months after the operation. Conclusion STA-MCA bypass is a safe and effective method to treat the patients with ischemic stroke caused by stenosis of MCA.
引文
[1]梁汉祥.高分辨磁共振管壁成像技术在颅内动脉瘤破裂风险评估中的可行性[J].检验医学与临床,2017,14(3):331-332,335.
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[7]张莎莎,陈雪涛,王海音,等.中青年健康男性血压水平与颅内血管血流动力学参数间关系的研究[J].空军医学杂志,2017,33(1):39-43.
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[10]汤海潮,许晓丹,姚懿函,等.动静脉联合应用重组组织型纤溶酶原激活剂治疗超时间窗急性脑梗死患者近期预后影响因素分析[J].临床军医杂志,2017,45:784-786.
[11]李舜,唐晓平,文军,等.成人出血型烟雾病合并颅内动脉瘤的诊治及预后分析[J].中国临床神经外科杂志,2017,22(4):213-215.
[12]李珊珊,李国营.缺血性脑卒中中药防治的研究进展[J].解剖学研究,2016,38(3):200-202.
[13]钱小蔷,徐宇浩,于明,等.尿激肽原酶与胰激肽原酶序贯治疗前循环非进展性脑梗死的效果观察[J].江苏大学学报(医学版),2017,27(2):176-178,182.
[2] Low SW, Teo K, Lwin S, et al. Improvement in cerebralhemodynamic parameters and outcomes after superficialtemporal artery-middle cerebral artery bypass in patientswith severe stenoocclusive disease of the intracranial inter-nal carotid or middle cerebral arteries[J]. J Neurosurg,2015, 123(3):662-669.
[3] Indo M, Oya S, Matsui T. Ruptured basilar tip aneurysm ina patient with bilateral internal carotid artery occlusionsuccessfully treated with bilateral superficial temporalartery-middle cerebral artery anastomoses:case report[J].World Neurosurg, 2016, 2(86):512.e5-8.
[4] Shrivastava A, Srivastava T, Saxena R. CT angiographicevaluation of pattern and distribution of stenosis and itsassociation with risk factors among indian ischemic strokepatients[J]. Pol J Radiol, 2016, 7(81):357-362.
[5] Yu Z, Shi X, Qian H, et al. Internal maxillary artery to intra-cranial artery bypass:a case series of 31 patients withchronic internal carotid/middle cerebral arterial-scleroticsteno-occlusive disease[J]. Neurol Res, 2016, 38:420-428.
[6]程明,王跃.重复经颅磁刺激联合丁苯酞对脑卒中后运动功能恢复及血清学指标的影响[J].东南大学学报(医学版),2017,36(6):946-950.
[7]张莎莎,陈雪涛,王海音,等.中青年健康男性血压水平与颅内血管血流动力学参数间关系的研究[J].空军医学杂志,2017,33(1):39-43.
[8]李瑞英,陈会生.急性缺血性脑卒中早期神经功能恶化研究现状及进展[J].临床军医杂志,2017,45(2):136-139.
[9]何平. 3种溶栓方案对急性大脑中动脉闭塞性脑梗死患者近远期疗效及并发症的影响[J].检验医学与临床,2017,14(23):3495-3496,3499.
[10]汤海潮,许晓丹,姚懿函,等.动静脉联合应用重组组织型纤溶酶原激活剂治疗超时间窗急性脑梗死患者近期预后影响因素分析[J].临床军医杂志,2017,45:784-786.
[11]李舜,唐晓平,文军,等.成人出血型烟雾病合并颅内动脉瘤的诊治及预后分析[J].中国临床神经外科杂志,2017,22(4):213-215.
[12]李珊珊,李国营.缺血性脑卒中中药防治的研究进展[J].解剖学研究,2016,38(3):200-202.
[13]钱小蔷,徐宇浩,于明,等.尿激肽原酶与胰激肽原酶序贯治疗前循环非进展性脑梗死的效果观察[J].江苏大学学报(医学版),2017,27(2):176-178,182.