标题：STA-MCA+EDMS和EDAMS血管融合术治疗烟雾病的疗效比较研究

      作者：孙娴，王培丽，崔圆元    复旦大学附属华山医院东院神经外科，上海 201206

      卷次： 2023年34卷17期

      【摘要】 目的 比较颞浅动脉-大脑中动脉分支吻合术结合脑-硬脑膜-肌肉-血管融合术(STA-MCA+EDMS)和脑-硬脑膜-动脉-肌肉血管融合术(EDAMS)治疗烟雾病患者的临床疗效。方法 选取2020年1月至2022年1月复旦大学附属华山医院东院神经外科收治的 92例烟雾病患者为研究对象，按照随机数表法分为观察组(应用STA-MCA+EDMS术)和对照组(应用EDAMS术)，每组46例。比较两组患者治疗后的临床疗效；于术后1 d和术后3个月，采用改良Rankin评分法评价两组患者神经功能恢复情况；分别在术前及术后3个月使用经颅多普勒超声测量脑血流量、脉压及血流峰值；于术前3 d及术后1周采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(Mo-CA)评估两组患者的认知功能；比较两组患者的术后并发症情况。结果 观察组患者的治疗总有效率为93.47%，明显高于对照组的76.09%，差异具有统计学意义(P<0.05)；术后3个月，观察组患者的改良Rankin评分为(1.11±0.12)分，明显低于对照组的(1.67±0.26)分，差异具有统计学意义(P<0.05)；术后1周，观察组患者的脑血流量、脉压、血流峰值分别为(13.54±2.33) mm/s、(35.63±15.33) mmHg、(172.59±19.35) cm/s，明显高于对照组的(11.35±1.58) mm/s、(26.34±10.55) mmHg、(150.68±18.74) cm/s，差异均有统计学意义(P<0.05)；术后 1周，观察组患者的MMSE得分、MoCA得分分别为(27.49±0.12)分、(27.98±0.41)分，明显高于对照组的(25.68±0.11)分、(25.68±0.11)分，差异均有统计学意义(P<0.05)；观察组患者术后心律失常、肾功能衰竭、术后感染的发生率分别为6.52%、4.34%、6.52%，明显低于对照组的21.74%、17.39%、23.91%，差异均有统计学意义(P<0.05)。结论 STA-MCA+EDMS治疗烟雾病能够增加患者脑血流量、脉压以及血流峰值，改善患者的神经功能和认知功能，减少术后并发症，临床应用效果较好。
      【关键词】 烟雾病；颞浅动脉-大脑中动脉分支吻合术结合脑-硬脑膜-肌肉-血管融合术；脑-硬脑膜-动脉-肌肉血管融合术；神经功能；认知功能
      【中图分类号】 R742 【文献标识码】 A 【文章编号】 1003—6350（2023）17—2493—06

Efficacy of superficial temporal artery-middle cerebral artery branch anastomosis combined with encepho-du-ro-myo-synangiosis versus encephalo-duro-arterio-myo-synangiosis in the treatment of patients with moyamo-ya disease.
SUN Xian, WANG Pei-li, CUI Yuan-yuan. Department of Neurosurgery, East Hospital of Huashan Hospital Af-filiated to Fudan University, Shanghai 201206, CHINA
【Abstract】 Objective To compare the clinical efficacy of superficial temporal artery-middle cerebral arterybranch anastomosis combined with encepho-duro-myo-synangiosis (STA-MCA + EDMS) and encephalo-duro-arte-rio-myo-synangiosis (EDAMS) in the treatment of patients with moyamoya disease. Methods Ninety-two patientswith moyamoya disease admitted to the Department of Neurosurgery, East Hospital of Huashan Hospital Affiliated to Fu-dan University from January 2020 to January 2022 were selected as the research objects. They were randomly divided in-to an observation group (using STA-MCA+EDMS) and a control group (using EDAMS), with 46 patients in each group.The clinical efficacy of the two groups after treatment was compared. At 1 day and 3 months after operation, the neuro-logical function recovery of the two groups was evaluated by modified Rankin score. Transcranial Doppler ultrasoundwas used to measure cerebral blood flow, pulse pressure, and peak blood flow before and 3 months after surgery.Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate the cogni-tive function of the two groups at 3 days before operation and 1 week after operation. The postoperative complicationswere compared between the two groups. Results The total effective rate in the observation group was 93.47%, whichwas significantly higher than 76.09% in the control group (P<0.05). Three months after surgery, the modified Rankinscore in the observation group was (1.11±0.12) points, which was significantly lower than (1.67±0.26) points in the con-trol group (P<0.05). One week after surgery, the cerebral blood flow, pulse pressure, and peak blood flow in the observa-tion group were (13.54±2.33) mm/s, (35.63±15.33) mmHg, and (172.59±19.35) cm/s, respectively, which were signifi-cantly higher than (11.35±1.58) mm/s, (26.34±10.55) mmHg, (150.68±18.74) cm/s in the control group (P<0.05). Oneweek after surgery, the MMSE score and MoCA score in the observation group were (27.49±0.12) points and (27.98±0.41) points, respectively, which were significantly higher than (25.68±0.11) points and (25.68±0.11) points in the con-trol group (P<0.05). The incidence rates of postoperative complications such as arrhythmia, renal failure, and postopera-tive infection in the observation group were 6.52%, 4.34%, and 6.52%, respectively, which were significantly lower than21.74%, 17.39%, and 23.91% in the control group (P<0.05). Conclusion STA-MCA+EDMS in the treatment of moyam-oya disease can increase cerebral blood flow, pulse pressure, and peak blood flow, improve neurological function and cog-nitive function of patients, reduce postoperative complications, which has good clinical application effect.
      【Key words】 Moyamoya disease; Superficial temporal artery-middle cerebral artery branch anastomosis com-bined with encepho-duro-myo-synangiosis (STA-MCA+EDMS); Encephalo-duro-arterio-myo-synangiosiss (EDAMS);Nerve function; Cognitive function