摘要： 目的 对比分析不同发病类型和不同术式烟雾病患者脑血管搭桥术后短期预后。方法 纳入2010年1月至2011年10月首都医科大学附属北京天坛医院收治的44例烟雾病患者，均行脑血管搭桥术，术后3个月采用美国国立卫生研究院卒中量表（NIHSS）评估神经功能改善并观察临床症状改善，DSA或CTA判断桥血管是否通畅，记录手术相关并发症。结果 术后3个月，桥血管均保持通畅，无一例发生手术相关并发症。根据发病类型分为缺血型、出血型和混合型3组，缺血型患者术后3个月神经功能（χ²=3.853，P=0.000；χ²=4.110，P=0.000）和临床症状（χ²=3.934，P=0.000；χ²=4.138，P=0.000）改善情况优于出血型和混合型患者。根据术式分为前-额搭桥术、前-颞搭桥术、后-额搭桥术和后-颞搭桥术4组，行前-额搭桥术的患者神经功能改善情况优于前-颞搭桥术（χ²=2.079，P=0.038），行后-额搭桥术的患者神经功能和临床症状改善情况分别优于前-颞搭桥术（χ²=2.909，P=0.004；χ²=2.812，P=0.005）和后-颞搭桥术（χ²=2.295，P=0.022；χ²=2.580，P=0.010）。结论 缺血型烟雾病患者术后短期预后优于出血型和混合型患者，且行前-额搭桥术和后-额搭桥术的患者术后短期预后优于前-颞搭桥术和后-颞搭桥术。

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, 预后

Abstract: Objective In this study, short-term prognosis of cerebral revascularization was evaluated by comparative analysis of patients with moyamoya disease (MMD) with different disease types and different bypass. Methods A total of 44 patients with MMD treated in Beijing Tiantan Hospital Affiliated to Capital Medical University from January 2010 to October 2011 were enrolled. All patients underwent cerebral revascularization. The improvement of neurological function was evaluated by National Institutes of Health Stroke Scale (NIHSS) 3 months after surgery, and the improvement of clinical symptoms was observed. DSA or CTA were reviewed to determine whether the bridge vessels were unobstructed and surgical complications were recorded. Results DSA or CTA reexamination showed that the anastomosis was unobstructed, and no surgical complications occurred. Patients with MMD were divided into 3 groups according to the onset type:ischemic, hemorrhagic and mixed. Compared with hemorrhagic type and mixed type, neurological function improved 3 months after surgery in patients with ischemic type (χ²=3.853, P=0.001; χ²=4.110, P=0.001) and improvement of clinical symptoms (χ²=3.934, P=0.000; χ²=4.138, P=0.000) were better. According to the operation type, the patients were divided into 4 groups:anterior-frontal, anterior-temporal, posterior-frontal and posterior-temporal bypass. The improvement of neurological function in anterior-frontal bypass group was higher than that in anterior-temporal bypass group (χ²=2.079, P=0.038). The improvement of neurological function and clinincal symptooms in posterior-frontal bypass group were higher than those in anterior-temporal bypass group (χ²=2.909; P=0.004; χ²=2.812, P=0.005), and those in posterior-frontal bypass group were also higher than those in posterior-temporal bypass group (χ²=2.295, P=0.022; χ²=2.580, P=0.010). Conclusions Compared with the other 2 groups, symptoms of ischemic MMD may improved better than before, and the intraoperative selection of posterior-frontal and anterior-frontal bypass may be better than anterior-temporal and posterior-temporal bypass.

Key words: Moyamoya disease, Cerebral revascularization, Temporal arteries, Middle cerebral artery, Prognosis