股票融配资 学术动态 | 中南医院神经外科在Nature子刊报道烟雾病侧侧吻合能更好利用头皮动脉实现直接血运重建

2025-01-01 20:46

2024年11月25日蚂蚁森林神奇海洋今日答题最新正确答案

夜幕低垂，城市的灯火辉煌，却照不亮我心中的阴霾。老公出差的这些天，我一直在思考这个问题：婆婆来了，这个家会变成什么样？我知道，这不仅仅是一个简单的居住问题，更是两个家庭、两代人价值观和生活方式的碰撞。

学术动态神外前沿 255期

神外前沿讯，12月2日，武汉大学中南医院神经外科陈劲草教授（专访链接）、章剑剑教授（专访链接）团队在 Nature子刊-Scientific Reports（影响因子4.6，JCR分区Q1）上报道了侧侧搭桥新术式如何更好地改善烟雾病患者的血运重建。

研究发现，侧侧吻合技术能有效利用头皮动脉(scalp arteries)，尤其是颞浅动脉额支和枕动脉，通过保留的颞浅动脉远端在成年烟雾病患者中实现直接血运重建。头皮动脉可作为供体动脉的补充来源，对于血运重建效果欠佳的患者尤其有益。

论文信息

Role of scalp arteries in revascularization after side to side anastomosis in moyamoya disease patients

https://www.nature.com/articles/s41598-024-81362-6

据了解，由于烟雾病直接吻合手术后血流动力学变化复杂，患者可能会出现一系列术后并发症，比如复发性缺血、出血、认知功能减退、分水岭移位以及术后脑过度灌注综合征（CHS）等情况。

为了减少术后并发症并提高吻合手术的安全性，武汉大学中南医院神经外科团队于2022年开创了侧侧吻合吻合术。

研究者发现接受侧侧手术的患者脑过度灌注综合征症状更轻且持续时间更短。更为重要的是，研究者认为侧侧手术具备促进血流自我调节的潜力，能调动头皮动脉作为供体来源，并通过颞浅动脉的远端分支实现直接血运重建。

在本次研究中，通过更长时间的随访，研究者首次报道了在侧侧手术后，头皮动脉可通过保留的颞浅动脉远端参与直接血运重建。

在这项研究中，研究者招募了接受侧侧或端侧吻合的烟雾病患者，收集并对比了临床数据和血管造影参数。共纳入了44例接受端侧吻合以及40例接受侧侧吻合的烟雾病患者。

两组患者的基本特征以及术后Matsushima分级并无显著差异。不过，侧侧吻合组中分级为D级的患者比例（0%）低于端侧吻合组（11.4%，P = 0.028）。

与端侧吻合组相比，侧侧吻合组显示枕动脉（OA）在血运重建中的参与度更高（87.5%对56.8%，P = 0.002），而且颞浅动脉（STA）额支术后管径变化率（CCR）也更高（1.26 ± 0.43对1.04 ± 0.53，P = 0.038）。

这种差异在血运重建效果不佳的亚组中更为显著：在侧侧吻合组中，颞浅动脉额支的管径变化率和血运重建参与程度分别为1.163 ± 0.168和58.8%，而在端侧吻合组中，这两项指标仅分别为0.798 ± 0.494和6.7%。与端侧吻合组（分别为0.941 ± 0.216和37.5%）相比，侧侧吻合组的枕动脉管径变化率（1.133 ± 0.257）和参与度（82.4%）也更高。

Distributions of postoperative Matsushima grades in groups with different anastomosis procedure. Aintraoperative microscopic photographs showed the side-to-side (S-S) anastomosis between superficial temporal artery (STA) and the recipient artery (RA). The lower left panel showed the anastomosis after completion, and the lower right panel showed the indocyanine green fluorescence angiography corresponding to the surgical field, which showed the patency of the bypass. The dotted circle indicates the anastomosis site; B the bar chart showed the distribution of each postoperative Matsushima grades in end-to-side (E-S) group and S-S group, and the two groups have obvious differences in Matsushima grade D (P < 0.05); C, Illustrations of postoperative Matsushima grades A-C in the S-S group, and Matsushima grade D from E-S group. Red arrows showed the course of STA parietal branch, blue arrows indicated the RA, white dotted irregular rings inferred the areas of postoperative revascularization. DSA, digital subtraction angiography.

Illustrations of external carotid artery (ECA) branches involved in direct revascularization after side-side (S-S) bypasses. A preoperative digital subtraction angiography (DSA) from patient 1 showed the superficial temporal artery (STA) parietal (red arrows) and frontal (yellow arrows) branches, there was no obvious anastomosis between the two arteries. After S-S bypass, the DSA at postoperative 3 months showed the enlarged STA frontal branch (yellow thick arrows) contributed in the postoperative revascularization through the reserved distal end of STA parietal branch. Red dotted circle indicted the anastomosis site, blue arrow head indicated the filling of recipient artery, white dotted ring indicated the revascularization area; B, patient 2’s DSA showed obviously preoperative spontaneous anastomosis (white arrows) between the STA parietal branch (red arrows) and the occipital artery (OA) (green arrows) in scalp. 5 months after the S-S bypass (red dotted circle indicted the anastomosis site), the OA was enlarged and participated in postoperative revascularization via the reserved distal end of STA parietal branch, and archived moderate effect (green dotted oval). Blue arrow head indicated the filling of recipient artery; C, preoperative DSA from patient 3 showed no connection between the STA (red arrow) and OA (green arrow). 6 months after S-S bypass, spontaneous anastomoses (white arrows) were formed between the OA and distal donor STA, thus let OA flow entered the intracranial (white dotted oval); D, DSA at postoperative 12 months from patient 4 illustrated the co-participating of OA (green arrows) and STA frontal branch (yellow arrows) in postoperative revascularization (white dotted oval), although the STA parietal branch (red arrow) seemed weak even before surgery, the OA and STA frontal branch played the backup roles to direct revascularization and avoided the occurrence of complete no revascularization effect.

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神外前沿-中国神经外科新媒体；

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