摘要： 目的 探讨颞浅动脉-大脑中动脉（STA-MCA）搭桥术联合带蒂颞顶筋膜瓣贴敷术治疗烟雾病的有效性和安全性。方法 纳入2018年1月至2020年1月在天津市环湖医院行STA-MCA搭桥术联合带蒂颞顶筋膜瓣贴敷术的18例烟雾病患者，术后7天和6个月观察临床症状改善、手术切口愈合和并发症情况，PWI和DSA评估手术前后脑血流动力学改变以及桥血管吻合口通畅和侧支代偿情况。结果 18例患者均顺利完成手术，13例症状明显改善、4例无变化、1例构音障碍加重；5例术后发生脑过度灌注综合征、1例发生缺血性卒中，以及2例遗留肢体活动不利、1例行走不稳、1例记忆力减退；手术切口均愈合良好；脑血流量和脑血容量改善、平均通过时间和达峰时间轻度延迟，桥血管吻合口通畅。结论 STA-MCA搭桥术联合带蒂颞顶筋膜瓣贴敷术可以有效改善脑血流动力学，提高大脑中动脉供血区血流量和灌注，降低缺血性卒中发生率，同时可以保持颞肌正常解剖和功能，提高患者术后舒适度。

关键词: 脑底异常血管网病, 脑血管重建术, 颞动脉, 大脑中动脉, 外科皮瓣, 血流动力学

Abstract: Objective To investigate the efficacy and safety of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass combined with temporoparietal fascia flap in the treatment of moyamoya disease (MMD). Methods Retrospective analysis was performed on 18 patients with MMD who were treated with STA-MCA bypass combined with temporoparietal fascia flap in Tianjin Huanhu Hospital from January 2018 to January 2020. The improvement of clinical symptoms, incision healing and complications were observed 7 days or 6 months after operation. DSA and PWI were used to evaluate the changes of cerebral hemodynamics, patency of bridge anastomosis and collateral compensation in pre-and post-operation. Results During the postoperative and follow-up period, 13 cases showed significant improvement in clinical symptoms, 4 cases showed no obvious improvement, one case was worse than before operation, 5 cases had cerebral hyperperfusion syndrome (CHS), one case had ischemic stroke, 2 cases had residual limb movement disadvantage, one case had unsteady walking, and one case had memory loss. All the patients had good wound healing during the postoperative and follow-up period. All operative incisions healed well, cerebral blood flow (CBF) and cerebral blood volume (CBV) were improved, mean treasnit time (MTT) and time to peak (TTP) were slightly delayed, and blood flow at the bridge anastomis was unobvious. Conclusions STA-MCA bypass combined temporoparietal fascia flap can effectively improve cerebral hemodynamics, increase blood flow in MCA blood supply area and intracranial cerebral perfusion, reduce the incidence of ischemic stroke, maintain the normal anatomical position and the function of the temporalis muscle, and improve postoperative comfort of patients.

Key words: Moyamoya disease, Cerebral revascularization, Temporal arteries, Middle cerebral artery, Surgical flaps, Hemodynamics