Zhongguo cuzhong zazhi (Jul 2024)

受体动脉不同临时阻断策略在烟雾病颞浅动脉-大脑中动脉搭桥术中的应用比较 Comparison of Different Temporary Occlusion Strategies for Recipient Arteries in the Application of Superficial Temporal Artery-Middle Cerebral Artery Bypass for Moyamoya Disease

  • 陈方舟，龙廷翰，陈俊达，温运宇，陈思源，张国忠，李明洲，张世超，康慧斌，冯文峰，漆松涛，王刚 (CHEN Fangzhou, LONG Tinghan, CHEN Junda, WEN Yunyu, CHEN Siyuan, ZHANG Guozhong, LI Mingzhou, ZHANG Shichao, KANG Huibin, FENG Wenfeng, QI Songtao, WANG Gang )

DOI
https://doi.org/10.3969/j.issn.1673-5765.2024.07.005
Journal volume & issue
Vol. 19, no. 7
pp. 762 – 768

Abstract

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目的 探讨颞浅动脉-大脑中动脉端侧吻合术中不同临时阻断技术的效果及可靠性。 方法 回顾性分析2015年1月—2023年4月南方医科大学南方医院神经外科收治的接受直接搭桥术治疗的烟雾病患者资料，根据临时阻断策略的不同将患者分为3组：①有垫片、多阻断夹阻断组（multi-clips+rubber pad group，M+R组）；②无垫片、多阻断夹阻断组（multi-clips group，M组）；③无垫片、单阻断夹阻断组（single-clip group，S组）。比较组间临时阻断时间、受体动脉切开后有无渗血、术中穿支血管损伤以及术后新发脑梗死情况。 结果 共355例患者、360个大脑半球纳入分析，按大脑半球统计患者360例，其中男性188例，女性172例，平均年龄为（43.8±0.7）岁。其中M+R组45例，M组191例，S组124例。3组平均阻断时间：M+R组为（37.9±9.8）min，M组为（20.9±9.0）min，S组为（11.0±3.5）min，组间差异有统计学意义（P＜0.001）。阻断后受体动脉管腔内渗血以及术中穿支血管损伤发生率：M+R组为8.89%（阻断后受体动脉渗血4例），M组为14.66%（阻断后受体动脉渗血19例，术中穿支血管损伤8例，临时阻断部位有血栓形成1例），S组为5.65%（阻断后受体动脉渗血7例），组间差异无统计学意义（P>0.05）。术后新发脑梗死发生率差异无统计学意义（P>0.05）。 结论 单阻断夹阻断策略安全、有效，能显著缩短临时阻断时间，可以优先考虑作为颞浅动脉-大脑中动脉端侧吻合过程中的临时阻断策略。 Abstract: Objective To investigate the effects and reliability of different temporary occlusion techniques in end-to-side anastomosis of the superficial temporal artery-middle cerebral artery. Methods A retrospective analysis was conducted on the data of patients with Moyamoya disease who underwent direct bypass surgery in the Department of Neurosurgery, Nanfang Hospital, Southern Medical University, from January 2015 to April 2023. The patients were divided into three groups according to the different temporary occlusion strategies: ①multi-clips+rubber pad group (M+R group); ②multi-clips group (M group); and ③single-clip group (S group). Temporary occlusion time, presence of errhysis after recipient artery incision, intraoperative perforator vessel injury, and postoperative novel cerebral infarction were compared among the three groups. Results A total of 355 patients and 360 cerebral hemispheres were included in the analysis, and 360 patients were counted according to the number of cerebral hemispheres, including 188 males and 172 females, with an average age of (43.8±0.7) years. There were 45 cases in the M+R group, 191 cases in the M group, and 124 cases in the S group. The average occlusion time were (37.9±9.8) minutes in the M+R group, (20.9±9.0) minutes in the M group, and (11.0±3.5) minutes in the S group, with significant differences between the groups (P0.05). There was no significant difference in the incidence of novel cerebral infarctions postoperatively (P>0.05). Conclusions The single-clip occlusion strategy is safe and effective, which significantly shortens the temporary occlusion time, and should be prioritized as the temporary occlusion technique in end-to-side anastomosis of the superficial temporal artery-middle cerebral artery.

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