不同临床分型、影像学分期烟雾病的治疗策略与疗效

目的探讨不同临床分型、不同影像学分期烟雾病患者的治疗策略。方法回顾性分析2010~2013年收治的39例烟雾病患者的临床分型、影像学分期与治疗方法;术后采用CT血管成像(CTA)、CT灌注(CT perfusion,CTP)和数字减影血管造影(DSA)评价疗效,平均随访(21.3±3.1)个月(7~44个月)。结果Ⅰ~Ⅴ型患者34例,其中6例接受脑-硬膜-肌肉血管融合术,28例接受综合手术治疗(颞浅动脉-大脑中动脉吻合+脑-硬膜-肌肉血管融合术),4例首次手术半年后行对侧综合手术治疗;Ⅵ型患者5例,急诊行颅内血肿清除+去骨瓣减压+脑-硬膜-肌肉血管融合术。Ⅰ~Ⅱ期患者一般选择随访观察及保守治疗;Ⅲ期以上患者接受颅内外血管重建手术治疗,Ⅴ期及Ⅵ期患者采用个体化设计皮瓣、骨窗、硬膜翻转贴敷,以最大限度保留术前已自发形成的颅内外血管吻合。随访期间患者临床症状明显改善,脑血流灌注较术前改善,脑血流量(CBF)、脑血容量(CBV)较术前增加,达峰时间(TTP)较术前缩短,差异有统计学意义(P<0.05),这些变化随着随访时间的延长而更加明显。结论根据烟雾病患者不同的临床分型、影像学分期,采取不同的治疗方法,可以使患者获得良好的临床效果。

Treatment strategy and efficacy for moyamoya disease of different clinical types and radiographic stages

Objective To discuss the efficacy and treatment strategy of different clinic type and radiographic stage moyamoya disease . Methods Retrospectively review the data of 39 patients with moyamoya disease, who were treated in our medical center from April 2010 to December 2013. Analysis was focus on efficacy, treatment strategy and different clinical types and radiographic stages. The average follow-up time is 21.3±3.1 months(Range: 7-44months). Results There were 34 patients with type I-V moyamoya disease, including 6 patients treated by encepho-duro-myo-synangiosis (EDMS), 28 patients treated by STA-MCA anastomosis combined with EDMS, 4 patients received second surgery on the other hemisphere 6 months after first surgery. There were 5 patients with type VI moyamoya disease, who underwent emergency surgery of cerebral hematoma evacuation decompressive craniectomy EDMS. Stage I and II patients were treated by conservative therapies, while stage III-VI were treated by different types of extra-intra cerebrovascular reconstruction according. During follow-up period, all patients had clinical condition improvement. CTP imaging showed a significant increase of the rCBF and rCBV but a decrease of rTTP after the operation, the change was much more significant 6 months after operation. Conclusion This study showed treat moyamoya disease patients with different clinical types and radiographic stages via different strategy, can achieve good therapeutic effect.