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大脑中动脉-颞浅动脉搭桥术联合脑-硬脑膜血管融通术治疗烟雾病患者的安全性分析

Safety analysis of STA-MCA bypass combined with EDAS in the treatment of patients with moyamoya disease.

作者信息

Zhu Chao, Wang Yunhong, Li Junnan

机构信息

Neurosurgery Department, Pu'er People's Hospital, Pu'er, Yunnan, China.

出版信息

Medicine (Baltimore). 2025 Mar 21;104(12):e41769. doi: 10.1097/MD.0000000000041769.

Abstract

This study evaluates the clinical efficacy and safety of superficial temporal artery to middle cerebral artery (STA-MCA) bypass combined with encephalo-duro-arterio-synangiosis (EDAS) in the treatment of moyamoya disease. A total of 80 patients with moyamoya disease who were treated at our institution between January 2022 and January 2024 were enrolled and randomly assigned to 2 groups: a control group (n = 40) and an observation group (n = 40). The control group underwent EDAS, while the observation group received STA-MCA bypass in addition to EDAS. Surgical success rates, cerebral blood flow (CBF) efficacy markers, neurological function scores, and surgical safety were comprehensively assessed in both groups. The surgical success rate in the observation group was 95.00%, significantly higher than 75.00% in the control group (P < .05). Three days postoperatively, the observation group exhibited significantly higher CBF and cerebral blood volume compared to the control group, with reduced time to peak and mean transit time (P < .05). One month after surgery, the observation group had significantly lower modified Rankin Scale and National Institutes of Health Stroke Scale scores, and higher mini-mental state examination scores compared to the control group (P < .05). The incidence of perioperative complications was 15.00% in the observation group and 17.50% in the control group, with no significant difference between the groups (P > .05). STA-MCA bypass combined with EDAS significantly improves surgical success rates, cerebral hemodynamic parameters, and neurological function outcomes in patients with moyamoya disease without increasing the incidence of surgical complications, indicating favorable safety.

摘要

本研究评估颞浅动脉-大脑中动脉(STA-MCA)搭桥联合脑-硬脑膜-动脉-血管融合术(EDAS)治疗烟雾病的临床疗效及安全性。选取2022年1月至2024年1月在我院接受治疗的80例烟雾病患者,将其随机分为2组:对照组(n = 40)和观察组(n = 40)。对照组接受EDAS治疗,观察组在EDAS基础上还接受STA-MCA搭桥治疗。对两组患者的手术成功率、脑血流(CBF)疗效指标、神经功能评分及手术安全性进行综合评估。观察组手术成功率为95.00%,显著高于对照组的75.00%(P < 0.05)。术后3天,观察组的CBF和脑血容量显著高于对照组,达峰时间和平均通过时间缩短(P < 0.05)。术后1个月,观察组的改良Rankin量表评分和美国国立卫生研究院卒中量表评分显著低于对照组,简易精神状态检查表评分高于对照组(P < 0.05)。观察组围手术期并发症发生率为15.00%,对照组为17.50%,两组间差异无统计学意义(P > 0.05)。STA-MCA搭桥联合EDAS可显著提高烟雾病患者的手术成功率、脑血流动力学参数及神经功能结局,且不增加手术并发症发生率,安全性良好。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fad6/11936565/26b3e56f73d8/medi-104-e41769-g001.jpg

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