目的:分析颞浅动脉-大脑中动脉(STA-MCA)搭桥术联合颞肌补片与单纯STA-MCA搭桥术治疗烟雾病的临床疗效。
方法:选取2019年1月至2021年12月在我院确诊为烟雾病的73例患者。其中,将43例接受STA-MCA旁路移植术联合颞肌补片治疗的患者分为实验组,而仅接受STA-MCA旁路移植术的30例患者为对照组。比较2组的临床疗效,总有效率,术后6个月疾病控制率,改良Rankin量表(mRS)和Karnofsky表现量表(KPS)评分在手术前及术后第7天和6个月,术前、术后24小时格拉斯哥昏迷量表评分的变化。此外,统计术后1年内脑缺血和脑出血的发生率。脑灌注相关指标包括相对平均渡越时间(rMTT),相对峰值时间,相对脑血流量(rCBF),比较两组术后第7天和第6个月的相对脑血容量(rCBV),并分析手术前脑灌注相关指标对患者临床疗效的预测价值。
结果:两组术后格拉斯哥昏迷评分(P>0.05)相似,两组临床疗效及总有效率差异均有统计学意义(均P<0.05)。与手术前相比,两组的mRS评分均下降,而KPS评分在术后第7天增加(均P<0.05)。此外,与手术前和手术后第七天相比,两组患者术后6个月mRS评分均下降,而KPS评分增加(均P<0.05)。两组均显示rMTT和rTPP降低,术后第7天rCBF、rCBV较术前升高(均P<0.05)。此外,两组仍显示rMTT和rTPP降低,术后6个月rCBF和rCBV较术前和术后第7天升高(均P<0.05)。最值得注意的是,术后6个月试验组脑灌注相关指标较对照组改善(均P<0.05)。缓解组rCBF和rCBV水平明显高于非缓解组(均P<0.05)。根据ROC分析,rCBF和rCBV预测患者临床疗效的曲线下面积分别为0.842和0.823。
结论:颞浅动脉-大脑中动脉旁路移植术联合颞肌补片治疗烟雾病患者的临床总治愈率较高,可缓解昏迷。
OBJECTIVE: To analyze the clinical efficacy of superficial temporal artery-middle cerebral artery (STA-MCA) bypass grafting surgery combined with temporal muscle patch and STA-MCA bypass grafting surgery alone on patients with moyamoya disease.
METHODS: Totally 73 patients confirmed with moyamoya disease in our hospital between January 2019 and December 2021 were enrolled. Among them, 43 patients treated with STA-MCA bypass grafting surgery combined with temporal muscle patch were assigned to the experiment group, whereas 30 patients treated with STA-MCA bypass grafting surgery alone to the control group. The following items of the 2 groups were compared: clinical efficacy, total effective rate, and disease control rate 6 months after surgery, the changes of modified Rankin Scale (mRS) and Karnofsky performance scale (KPS) scores before and on the seventh day and 6 months after surgery, and changes of Glasgow coma scale scores before and 24 hours after surgery. In addition, the incidences of cerebral ischemia and cerebral hemorrhage within 1 year after surgery were counted. The cerebral perfusion-associated indexes including relative mean transit time (rMTT), relative time-to-peak, relative cerebral blood flow (rCBF), and relative cerebral blood volume (rCBV) on the seventh day and 6 months after surgery were compared between the 2 groups, and the predictive value of cerebral perfusion-associated indexes before surgery for clinical efficacy on patients was analyzed.
RESULTS: The Glasgow coma scale score after surgery ( P >0.05) was similar between the 2 groups, but the clinical efficacy and total effective rate of the 2 groups were notably different (both P <0.05). Compared with those before surgery, mRS scores of both groups declined, whereas KPS scores increased (both P <0.05) on the seventh day after surgery. In addition, compared with those before surgery and on the seventh day after surgery, mRS scores of both groups decreased 6 months after surgery, whereas KPS scores increased (both P <0.05). Both the groups showed decreased rMTT and rTPP, and increased rCBF and rCBV on the seventh day after surgery than those before surgery (all P <0.05). In addition, both the groups still showed decreased rMTT and rTPP, and increased rCBF and rCBV 6 months after surgery than those before surgery and on the seventh day after surgery (all P <0.05). Most notably, the experimental group displayed improved cerebral perfusion-associated indexes than the control group 6 months after surgery (all P <0.05). The relief group showed notably higher rCBF and rCBV levels than the nonrelief group (both P <0.05). According to ROC analysis, the areas under the curves of rCBF and rCBV in forecasting the clinical efficacy on patients were 0.842 and 0.823, respectively.
CONCLUSIONS: Superficial temporal artery-middle cerebral artery bypass grafting surgery combined with temporal muscle patch can deliver a higher total clinical curative rate for patients with moyamoya disease and can alleviate their coma.