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目的探讨大动脉炎导致颅内缺血的血管旁路术的选择及疗效。方法回顾性分析2005—2015年首都医科大学宣武医院血管外科14例Ⅰ型头臂型大动脉炎致颅内缺血病人的临床资料。14例均采用动脉旁路术,其中单侧颈总动脉闭塞且willis环不完整行升主动脉-单侧颈内动脉搭桥5例;双侧颈总动脉闭塞且willis环完整行升主动脉-单侧颈内动脉搭桥5例;双侧颈总动脉及双侧锁骨下动脉闭塞且willis环完整行升主动脉-双侧腋动脉搭桥1例;单侧颈总动脉及双侧锁骨下动脉闭塞且willis环完整行升主动脉-双侧腋动脉搭桥3例。结果 14例病人手术成功,共搭桥18条人工血管,1例术后出现右下肺感染及胸腔积液,1例术后人工血管急性血栓形成。病人术后症状明显改善10例、好转3例、无变化1例,近期治疗有效率为92.9%(13/14),人工血管通畅率为94.4%(17/18)。随访5~115个月,1例在术后5个月突发脑出血死亡,3条血管分别在术后6、66、79个月发生单侧颈内动脉人工血管闭塞,其余13条人工血管通畅,通畅率为81.3(13/16)。结论大脑willis环完整性对Ⅰ型头臂型大动脉炎导致颅内缺血的血管旁路术的选择有一定参考价值。
Objective To investigate the choice and curative effect of arterial bypass for intracranial ischemia caused by arteritis. Methods The clinical data of 14 patients with type Ⅰ brachial arteritis caused by intracranial ischemia in Xuanwu Hospital of Capital Medical University from 2005 to 2015 were analyzed retrospectively. All of the 14 cases were treated by arterial bypass, in which unilateral common carotid artery occlusion and incomplete willis ring ascending aorta - unilateral internal carotid artery bypass in 5 cases; bilateral common carotid artery occlusion and complete willis ring ascending aorta - Unilateral carotid artery bypass in 5 cases; Bilateral common carotid artery and bilateral subclavian artery occlusion and willis ring complete line of ascending aorta - bilateral axillary bypass in 1 case; unilateral common carotid artery and bilateral subclavian artery occlusion And willis ring complete line ascending aorta - bilateral axillary artery bypass graft in 3 cases. Results The operation of 14 patients was successful. A total of 18 artificial blood vessels were bridged. One patient had right lower quadrant pulmonary infection and pleural effusion after operation, and 1 postoperative acute vascular thrombosis. The symptoms of patients improved significantly in 10 cases, improved in 3 cases, no change in 1 case, the recent treatment of effective rate was 92.9% (13/14), artificial vascular patency rate was 94.4% (17/18). The patients were followed up for 5 to 115 months. One patient died of sudden cerebral hemorrhage 5 months after operation. Unilateral internal carotid artery occlusion occurred in 3, 6, 6 and 69 months postoperatively. The remaining 13 artificial blood vessels Unobstructed, patency rate was 81.3 (13/16). Conclusion The brain willis ring integrity of type Ⅰ arm aortitis leading to intracranial ischemia of the choice of bypass has some reference value.