中国脑血管病杂志2013，Vol.10Issue(4)：169-173,5.DOI:10.3969/j.issn.1672-5921.2013.04.001
脑硬脑膜颞浅动脉血管融通术治疗出血型烟雾病的疗效及其影响因素分析
Efficacy and its influencing factors of encephalo-duro-arterio-synangiosis for treatment of hemorrhagic moyamoya disease
摘要
Abstract
Objective To investigate the efficacy and its influencing factors of encephalo-duro-ar-terio-synangiosis (EDAS) in the treatment of hemorrhagic moyamoya disease. Methods The clinical data of 85 patients with hemorrhagic moyamoya disease, who admitted to the 301st Hospital of PLA for bilateral EDAS treatment and were followed up with DSA after procedure, were analyzed retrospectively. The effects of gender, age at first operation , preoperative bleeding frequency, cerebral glucose metabolism (positron emission tomography [ PET ] ) evaluation, types of intracerebral hemorrhage, having cerebral ischemic symptoms or not, stages of moyamoya disease, affecting posterior cerebral artery or not, having complications ( hypertension, heperlipemia or hyperglycaemia) or not on the result of revascularization ( DSA evaluation) . Results ①85 patients (170 sides) were followed up for 6 to 43 months by DSA after procedure. The mean follow-up time was 13 ±8 months. The effective rate of revascularization of 170 hemispheres was 50. 6% (86/170). Two patients had rebleeding during the follow-up period. DSA showed that the extracranial vessels had large number of intracranial compensation. ②Univariate analysis showed that the effective rate of EDAS decreased gradually with the increase of age (P = 0. 003). The efficacy of vascular reconstruction was even better in patients who had ischemic symptoms before bleeding ( P = 0. 000 1) , preoperative reduced or defective brain metabolism ( P = 0. 000 1 ) and multiple attacks of bleeding before procedure (P = 0. 057). ③ Multivariate logistic regression analysis showed that advanced age ( OR = 1.919, 95 % CI 1. 163 to 3. 167; P = 0.011) was an independent risk factor for affecting the surgical effect in patients with hemorrhagic moyamoya disease. Having ischemic symptoms before bleeding ( OR =0. 252, 95% CI 0.067 to 0. 952; P =0. 042) and decreased or defects of cerebral metabolism ( OR = 0. 016, 95% CI 0.004 to 0. 060;P = 0. 000) were the protective factors for affecting the surgical effect. Conclusion The younger the age, the patients with ischemic symptoms and cerebral metabolic disturbance before procedure, the better effect of revascularization will obtain.关键词
脑底异常血管网病/颅内出血/脑血管重建术/治疗效果/危险因素Key words
Moyamoya disease/ Intracranial hemorrhage/ Cerebral revascularization/ Outcome/ Risk factors引用本文复制引用
刘鹏,李德生,杨伟中,段炼..脑硬脑膜颞浅动脉血管融通术治疗出血型烟雾病的疗效及其影响因素分析[J].中国脑血管病杂志,2013,10(4):169-173,5.基金项目
国家自然科学基金资助项目(81171083) （81171083）
解放军第三○七医院创新科研基金重点项目(ZD-2012-04) （ZD-2012-04）
