PDF(Pubmed)
Abstract：
UNASSIGNED: This study aimed to examine the effect of newly developed scissors-attached micro-forceps in superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD).
UNASSIGNED: Of 179 consecutive STA-MCA anastomoses on 95 hemispheres of 71 MMD patients at the University of Fukui Hospital between 2009 and 2023, 49 anastomoses on 26 hemispheres of 21 patients were enrolled in this retrospective cohort clinical trial intraoperative indocyanine green video-angiography did not demonstrate bypass patency in three anastomoses in two patients who were excluded. Twenty-one anastomosis in 19 hemispheres of 16 patients were performed using the conventional micro-forceps (conventional group, CG), and 25 anastomoses in 22 hemispheres of 19 patients were performed using scissors-attached micro-forceps (scissors group, SG). A small infarction near the anastomotic site detected using postoperative diffusion-weighted imaging was defined as anastomotic site infarction (ASI). Factors affecting the occurrence of ASI were examined by univariate, logistic regression, and receiver operating curve (ROC) analysis.
UNASSIGNED: There were no significant differences in clinical parameters such as age, sex, number of sacrificed branches, number of sacrificed large branches, and number of sutures between the CG and SG. However, the clamp time and occurrence of ASI were significantly lower in the SG than in the CG. Logistic regression analysis revealed that the clamp time was the only significant factor predicting the occurrence of ASI. A receiver operating curve analysis also revealed that the clamp time significantly predicted the occurrence of ASI (area under the curve, 0.875; cutoff value, 33.2 min).
UNASSIGNED: The newly developed scissors-attached micro-forceps could significantly reduce the clamp time and occurrence of ASI in STA-MCA anastomosis for MMD.
UNASSIGNED: Of 179 consecutive STA-MCA anastomoses on 95 hemispheres of 71 MMD patients at the University of Fukui Hospital between 2009 and 2023, 49 anastomoses on 26 hemispheres of 21 patients were enrolled in this retrospective cohort clinical trial intraoperative indocyanine green video-angiography did not demonstrate bypass patency in three anastomoses in two patients who were excluded. Twenty-one anastomosis in 19 hemispheres of 16 patients were performed using the conventional micro-forceps (conventional group, CG), and 25 anastomoses in 22 hemispheres of 19 patients were performed using scissors-attached micro-forceps (scissors group, SG). A small infarction near the anastomotic site detected using postoperative diffusion-weighted imaging was defined as anastomotic site infarction (ASI). Factors affecting the occurrence of ASI were examined by univariate, logistic regression, and receiver operating curve (ROC) analysis.
UNASSIGNED: There were no significant differences in clinical parameters such as age, sex, number of sacrificed branches, number of sacrificed large branches, and number of sutures between the CG and SG. However, the clamp time and occurrence of ASI were significantly lower in the SG than in the CG. Logistic regression analysis revealed that the clamp time was the only significant factor predicting the occurrence of ASI. A receiver operating curve analysis also revealed that the clamp time significantly predicted the occurrence of ASI (area under the curve, 0.875; cutoff value, 33.2 min).
UNASSIGNED: The newly developed scissors-attached micro-forceps could significantly reduce the clamp time and occurrence of ASI in STA-MCA anastomosis for MMD.
摘要：
■这项研究旨在研究新开发的剪刀附着的微型镊子在颞浅动脉至大脑中动脉（STA-MCA）吻合治疗烟雾病（MMD）中的作用。
■2009年至2023年在福井大学医院的71名MMD患者的95个半球的179个连续STA-MCA吻合术中，21名患者的26个半球的49个吻合术被纳入这项回顾性队列临床试验，术中吲哚菁绿视频血管造影在两名被排除在外的患者的三个吻合术中未显示旁路通畅。使用常规微型镊子对16例患者的19个半球进行了21个吻合（常规组，CG),19例患者的22个半球进行了25个吻合，使用剪刀附着的微型镊子（剪刀组，SG).使用术后扩散加权成像检测到吻合部位附近的小梗塞被定义为吻合部位梗塞（ASI）。影响ASI发生的因素通过单因素检查，逻辑回归，和受试者工作曲线(ROC)分析。
■临床参数，如年龄，性别,牺牲的分支数量，牺牲的大树枝的数量，以及CG和SG之间的缝线数量。然而,SG的钳夹时间和ASI发生率明显低于CG。Logistic回归分析显示，钳夹时间是预测ASI发生的唯一有意义的因素。受试者工作曲线分析还显示，钳位时间显着预测了ASI的发生（曲线下面积，0.875；截止值，33.2分钟)。
■新开发的带有剪刀的微型镊子可以显着减少MMD的STA-MCA吻合术中的钳夹时间和ASI的发生。
■2009年至2023年在福井大学医院的71名MMD患者的95个半球的179个连续STA-MCA吻合术中，21名患者的26个半球的49个吻合术被纳入这项回顾性队列临床试验，术中吲哚菁绿视频血管造影在两名被排除在外的患者的三个吻合术中未显示旁路通畅。使用常规微型镊子对16例患者的19个半球进行了21个吻合（常规组，CG),19例患者的22个半球进行了25个吻合，使用剪刀附着的微型镊子（剪刀组，SG).使用术后扩散加权成像检测到吻合部位附近的小梗塞被定义为吻合部位梗塞（ASI）。影响ASI发生的因素通过单因素检查，逻辑回归，和受试者工作曲线(ROC)分析。
■临床参数，如年龄，性别,牺牲的分支数量，牺牲的大树枝的数量，以及CG和SG之间的缝线数量。然而,SG的钳夹时间和ASI发生率明显低于CG。Logistic回归分析显示，钳夹时间是预测ASI发生的唯一有意义的因素。受试者工作曲线分析还显示，钳位时间显着预测了ASI的发生（曲线下面积，0.875；截止值，33.2分钟)。
■新开发的带有剪刀的微型镊子可以显着减少MMD的STA-MCA吻合术中的钳夹时间和ASI的发生。
