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目的 探讨由大动脉炎所致的脑缺血的外科治疗。方法 本文报导了我们自 1984年 6月至 1999年 9月治疗 93例因头臂型大动脉炎 (TA)所致脑缺血的临床经验。其中 ,男性 10例 ,女性 83例 ,升主动脉 -腋动脉或锁骨下动脉 -颈动脉搭桥 4 7例 ;锁骨下动脉 -颈动脉搭桥 7例 ;经皮腔内球囊成形 (PTA) 5例 ;合并支架置放术 1例。结果 显效 30 3% ,有效 34 9% ,改善 2 1 2 % ,无效 4 6 % ,死亡 9 0 % ;平均 4 8个月随访疗效分别为 :30 6 % ,38 8% ,16 3% ,4 1%和 2 0 % ;复发 8 2 %。结论 当脑供血不足时 ,于病情相对稳定阶段 ,应以积极正确的方法予以治疗。如有可能 ,PTA可作为首选 ,但术后易复发。据我们的经验 ,颈部四血管阻塞性病变在造影时多不能显示远端流出道。但升主动脉 -颈动脉搭桥在绝大多数情况下是可行的。然而 ,术后脑组织再灌注损伤至今仍未能完全解决。
Objective To investigate the surgical treatment of cerebral ischemia caused by aortitis. Methods This article reports the clinical experience of 93 cases of cerebral ischemia caused by TA with TA from June 1984 to September 1999. Among them, 10 males and 83 females received ascending aorta-axillary artery or subclavian artery-carotid artery bypass in 47 cases, subclavian artery-carotid artery bypass in 7 cases, percutaneous transluminal balloon angioplasty (PTA) in 5 cases One case was treated with stenting. The results were significantly improved 30 3%, effective 34 9%, improved 2 1 2%, invalid 46%, death 90%; average 48 months follow-up efficacy were: 30 6%, 38 8%, 16 3%, 4 1% and 20%; relapse 82%. Conclusion When the brain blood supply is insufficient, the patients should be treated in a positive and correct way during the relatively stable condition. If possible, PTA can be used as the preferred, but easy to relapse after surgery. According to our experience, four-vessel obstruction of the neck during angiography can not show the distal outflow tract. However, ascending aorta-carotid artery bypass is feasible in the vast majority of cases. However, postoperative brain tissue reperfusion injury has not yet been completely resolved.