李宏锴　徐海涛　杨升

[摘要] 目的 比較颞浅动脉-大脑中动脉分支吻合术结合脑-硬脑膜-肌肉-血管融合术（STA-MCA+EDMS）和脑-硬脑膜-动脉-肌肉血管融合术（EDAMS）治疗成人烟雾病的效果。 方法 回顾性分析2013年4月～2017年4月武汉大学人民医院神经外科收治的73例接受血管重建手术的成人烟雾病患者的临床资料，根据治疗方案不同分为STA-MCA+EDMS组35例和EDAMS组38例。使用全脑数字减影血管造影（DSA）、头颅CT灌注成像（CTP）和mRS评分等方法来评估血管重建效果，比较两组的疗效。记录并比较两组并发症情况及随访结果。 结果 STA-MCA+EDMS组血管重建优于EDAMS组，差异有统计学意义（P < 0.05）。STA-MCA+EDMS组CBF值：术后2周高于术前，术后3个月高于术前，术后3个月高于术后2周，差异均有统计学意义（P < 0.05）。STA-MCA+EDMS组mRS评分：术前高于术后3个月，术后2周高于术后3个月，术前高于术后2周，差异均有统计学意义（P < 0.05）。EDAMS组mRS评分：术前高于术后3个月，术后2周高于术后3个月，差异均有统计学意义（P < 0.05）；术前高于术后2个周，差异无统计学意义（P > 0.05）。STA-MCA+EDMS组术后2周mRS评分较EDAMS组低，差异无统计学意义（P > 0.05），STA-MCA+EDMS组术后3个月mRS评分较EDAMS组低，差异有统计学意义（P < 0.05）。EDAMS组围术期并发症发生率低于STA-MCA+EDMS组，STA-MCA+EDMS组随访期间再次发病率低于EDAMS组，差异均无统计学意义（P > 0.05）。 结论 STA-MCA+EDMS术相较于EDAMS术短期内疗效显著，可更好地建立起侧支循环，改善患者神经症状，围术期并发症发生率和术后复发率二者无显著差异，远期疗效有待进一步观察。

[关键词] 烟雾病；颞浅动脉-大脑中动脉吻合术；脑-硬脑膜-动脉-肌肉血管融合术；联合手术

[中图分类号] R6 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0058-04

[Abstract] Objective To compare the efficacy of Superficial temporal artery-middle cerebral artery anastomosis combining with original encephaloduromyosynangiosis （STA-MCA+EDMS） and encephalo-duro-arterio-myo-synangiosis （EDAMS） on the treatment for adult Moyamoya disease. Methods Seventy-three clinical cases of adult Moyamoya disease treated with vascular reconstruction in Wuhan People Hospital from April 2013 to April 2017 were enrolled for retrospective analysis. On the basis of different treatments， they were divided into two groups， STA-MCA+EDMS group with 35 cases and EMDS group with 38 cases. Digital subtraction angiography （DSA） results， computed tomography perfusion （CTP） results， modified Rankin scale （mRS） scores and treatment effecacy were compared between the two groups. Postoperative complications and follow-up results were recorded and compared. Results Revascularization was better in STA-MCA+EDMS group than the EMDS group， the difference was significant （P < 0.05）. Cerebral blood flow （CBF） value in the STA-MCA+EDMS group： 2 weeks post-operation was higher than that of 3 months post-operation； 3 months post-operation was higher than that before operation； 3 months post-operation was higher than that of 2 weeks post-operation； all the differences were statistically significant （P < 0.05）. The mRS scores in the STA-MCA+EDMS group： the scores before operation was higher than that of 3 months post-operation； 2 weeks post-operation scores higher than that of 3 months post-operation； the scores before operation was higher than that of 2 weeks post-operation； all the differences were statistically significant （P < 0.05）. The mRS scores in the EDAMS group： the scores before operation was higher than that of 3 months post-operation； 2 weeks post-operation scores higher than that of 3 months post-operation； the differences were significant （P < 0.05）. The scores before operation was higher than that of 2 weeks post-operation， and the difference had no significance （P > 0.05）. The mRS scores of 2 weeks post-operation in the STA-MCA+EDMS group was lower than that of EDAMS group， and the difference had no significance （P > 0.05）. The mRS scores of 3 month post-operation in the STA-MCA+EDMS group was lower than that of EDAMS group， and the difference was significant （P < 0.05）. Perioperative complication rate in the EDAMS group was lower than the STA-MCA+EDMS group； postoperative recurrent rate in the STA-MCA+EDMS group was lower than the EDAMS group； and the differences had no significance （P > 0.05）. Conclusion Compared to EDAMS， STA-MCA+EDMS has prominent efficacy in short period post operation. STA-MCA+EDMS builds collateral circulation better and improves patients neural symptoms. Perioperative complication rate and postoperative recurrent rate in the two groups have no differences. The long-term efficacy is expected to be observed.

[Key words] Moyamoya disease； Superficial temporal artery-middle cerebral artery anastomosis； Encephalo-duro-arterio-muscle-synangiosis； Combined surgery

烟雾病是一种原发性、病因不明的以双侧颈内动脉末端、大脑前动脉及大脑中动脉起始部慢性进行性狭窄或闭塞，并继发颅底异常血管网形成的疾病[1]。临床上主要表现为脑出血性或缺血性疾病。颅内外血管重建手术是治疗该病的主要方法，可有效防止缺血性卒中，同时也能降低出血风险[2]。血管重建手术主要包括：直接血管重建手术、间接血管重建手术、联合手术三种。目……