颞浅动脉-大脑中动脉双支血管搭桥短期安全性分析

目的探索颞浅动脉-大脑中动脉（STA-MCA）搭桥术在慢性颅内缺血性疾病中的应用，分析单支/双支STA-MCA端侧吻合术后短期的安全性差异。 方法回顾性分析了四川省医学科学院·四川省人民医院神经外科自2020年1月至8月收治并行STA-MCA端侧吻合手术治疗慢性颈内动脉系统闭塞的患者的临床资料，按照治疗方法将患者分为单支搭桥组和双支搭桥组。对比2组患者术后短期内出现脑血流过度灌注综合征、桥血管闭塞、颅内感染、头皮切口愈合不良等相关并发症的统计学差异。 结果本文共纳入患者35例，共行手术41次，其中单支搭桥25次，双支搭桥16次。2组患者术前临床资料比较差异无统计学意义（P>0.05）。单支搭桥组患者术后出现脑血流过度灌注综合征的几率（20%）低于双支搭桥组（44%），但差异无统计学意义（P=0.103）。单支搭桥组和双支搭桥组中术后7 d的CT脑血管成像未见桥血管显影的患者分别为2例和1例，2组比较差异无统计学意义（P=0.834）。2组患者术后均未出现颅内感染、切口愈合不良。 结论本研究目前暂时没有发现双支搭桥可能增加的手术风险，但是双支搭桥术后可能增加脑血流灌注较单支更为明显，后续研究将做进一步的量化研究，以评估该术式的临床意义。

Short-term safety of double barrel superficial temporal artery to middle cerebral artery bypass

ObjectiveTo explore the application of superficial temporal artery-middle cerebral artery (STA-MCA) bypass operation in chronic intracranial ischemic diseases and analyze the short-term safety after single/double STA-MCA end-to-side anastomosis. MethodsThe clinical data of patients with chronic internal carotid artery occlusion treated by end-to-side anastomosis involving STA-MCA in the Department of Neurosurgery of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from January to August 2020 were retrospectively analyzed. According to the treatment methods, the patients were divided into single bypass group and double bypass group. The statistical differences of complications such as cerebral hyperperfusion syndrome, bridge occlusion, intracranial infection and scalp necrosis in the short term after operation between the two groups were analyzed. ResultsA total of 35 patients underwent 41 operations, including 25 single bypass and 16 double bypass. There was no significant difference in clinical data between the two groups before operation (P>0.05). And there was no statistically significant difference neither in the rate of high perfusion response postoperative (20% in the single-branch group and 44% in the double-branch group, P=0.103) nor the rate of Bridge-vessel occlusion (8% vs 6%, P=0.834) in the CTA for 7 d after the operation. No patients in the two groups showed infection or scalp necrosis after operation. ConclusionThrough this study, there is no evidence that double bypass may increase the risk of surgery. However, the cerebral blood flow after double-bypass is more obvious increase than that after single-bypass, which will be further quantified in future studies to evaluate the clinical significance of this operation.