烟雾病联合血管重建术后可逆性神经功能障碍的预测因素

目的探讨烟雾病患者颅内外血管联合重建术后发生可逆性神经功能障碍(RND)的预测因素。方法回顾性分析123例烟雾患者及其实施的138例颅内外血管联合重建术,记录其人口统计资料,临床表现,既往病史,RND并发症,以及手术相关资料。结果共计13例(9.42%)术后RND,发生于12名患者中。术前临床症状多次发作(多次定义为3次及以上)、一次手术双侧血管重建与术后RND密切相关(P<0.05,P<0.01)。缺血型烟雾病患者术后RND发生率(13.89%)高于出血型烟雾病患者(3.85%),但差异无统计学意义(P>0.05)。缺血型烟雾病中首发症状为TIA术后RND发生率为21.74%,首发症状为脑梗死者10.20%,二者差异无统计学意义(P>0.05)。首发症状为TIA者,术后RND发生率明显高于出血型烟雾病(P<0.05)。患者年龄,性别,手术与上一次卒中时间间隔,血管重建方式,是否单侧烟雾病,既往甲状腺、免疫疾病、高血压等病史与术后RND无明显关系。结论颅内外血管联合重建术后,首发症状TIA者比出血型烟雾病更易发生RND。但首发症状TIA与脑梗死者之间,缺血型烟雾病与出血型烟雾病之间,术后RND发生率均无明显差异。术前临床症状反复多次发作、一次手术双侧血管重建为术后RND的预测因素,因此双侧烟雾病的颅内外血管联合重建术不建议一次完成,而应分次进行。

Prognostic factors associated with reversible neurologic deterioration after combined direct and indirect revascularization in patients with moyamoya disease

Objective Reversible neurologic deterioration(RND)is the distinctive complication after revascularization surgery in patients with moyamoya disease.The present study investigates the prognostic factors for RND after combined direct and indirect revascularization in patients with moyamoya disease.Methods A retrospective review of 123 patients with moyamoya disease undergoing 138 combined direct and indirect revascularization procedures was performed.Demographics,clinical manifestation,medical history,RND complications,and relevant information of operation were recorded.Results There were 13(9.42%)postoperative RND occurred in 12 patients.Preoperative multiple symptom episodes and one-staged bilateral revascularization were significantly correlated with postoperative RND(P<0.05 and P<0.01,respectively).The incidence rate(13.89%)of ischemic moyamoya disease’s postoperative RND was higher than hemorrhagic moyamoya disease(3.85%),but there was no significant difference between them(P>0.05).There were 21.74% of patients with TIA onset and 10.20% of patients with infarction onset suffered from postoperative RND,and there was no significant difference between them(P>0.05).The incidence rate of postoperative RND in patients with TIA onset was higher than hemorrhagic moyamoya disease(P<0.05).Postoperative RND had no significant correlation with sex,age at the time of surgery,type of surgical procedure,unilateral moyamoya disease or not,interval between the last attack and operation,and history of thyroid disease,hypertension,and autoimmune disease.Conclusions RND is more likely to occur in patients with TIA onset than hemorrhagic moyamoya disease after combined direct and indirect revascularization.The incidence rate of postoperative RND was no significant difference between TIA onset and infarction onset,there was no significant difference between ischemic and hemorrhagic moyamoya disease too.Preoperative multiple symptom episodes and one-staged bilateral revascularization are prognostic factors associated with postoperative RND in patients with moyamoya disease.Therefore,two unilateral revascularization procedures successively rather than one-staged bilateral revascularization procedures should be performed in patients with bilateral moyamoya disease.