联合旁路术式治疗烟雾病患儿随访结果分析

摘要：目的　了解烟雾病患儿行联合旁路手术的效果。方法　随访2016年以来采用颞浅动脉-大脑中动脉搭桥术联合脑-硬脑膜-颞肌贴敷方式治疗的9例5～12岁烟雾病患儿，与同时期相同术式的成人病例进行比较。结果　本组患儿中双侧大脑半球发病型8例，单侧型1例；缺血型16侧，出血型1侧；完成17侧颞浅动脉-大脑中动脉搭桥联合脑-硬脑膜-颞肌贴敷手术（出血型完成双侧）。2侧术后出现短暂的对侧面部抽搐现象。1侧术后3个月出现骨瓣松动。所有患儿在围手术期和远期随访中均未再发生脑缺血或脑出血，身体发育和学习成绩与同龄儿童相比无异常。儿童组与成人组术后并发症比较差异无统计学意义。结论　儿童烟雾病缺血型多发，联合的旁路手术能为5~12岁患儿提供安全有效的治疗方法，帮助患儿回归正常的生长和发育，预防脑卒中。

Analysis of follow-up results of Moyamoya disease in children after combined bypass surgery

Abstract: Objective To review the effect of combined bypass surgery for Moyamoya disease in children. Methods Data of 9 children (5 -12-years) with Moyamoya disease treated with superficial temporal artery-middle cerebral artery bypass and encephalo-duro-myo-synangiosis (EDMS) were followed up since 2016, and which were compared with dada of adult patients of the same surgical procedure in the same period. Results In this group of children, there were 8 cases with bilateral cerebral hemisphere disease, 1 case of unilateral cerebral hemisphere disease, 16 cases of ischemic type and 1 case of hemorrhagic type. Seventeen patients completed superficial temporal artery-middle cerebral artery bypass operation (hemorrhagic type was completed on both sides). The short-term contralateral facial twitching occurred in 2 children after surgery. The bone flap loosened in one case 3 months after operation. None of the children showed cerebral ischemia or cerebral hemorrhage during peri-operation and long-term follow-up, and there were no abnormalities in physical development and academic performance compared to children of the same age. There were no significant differences in complications after surgery between child group and adult group. Conclusion Moyamoya disease occurs frequently in children. The combined bypass surgery can provide the safe and effective treatment for children aged 5-12 years, help children return to normal physical growth and development, and prevent stroke.