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目的 探讨颈部动脉血流重建治疗重症多发性大动脉炎导致脑缺血的疗效,并探索经颅脑血管超声(TCD)的应用.方法 回顾性分析2003年1月至2012年12月在本中心行外科治疗的脑缺血型大动脉炎患者的资料.将41例患者分为A、B两组.A组22例术中应用TCD,B组19例未应用TCD.主要手术方式:A组采用升主动脉-双腋(肱)/锁骨下动脉人工血管旁路移植-单侧颈内动脉自体大隐静脉旁路移植术的患者为10例;采用升主动脉(主动脉弓)-双腋(肱)/锁骨下动脉人工血管旁路移植术的患者为7例;采用升主动脉--侧锁骨下动脉和一颈动脉人工血管旁路移植术的患者为3例;采用升主动脉--侧颈内动脉自体大隐静脉旁路移植术的患者为2例.B组分别为8、9、1、1例.在上述行升主动脉-双腋动脉人工血管旁路移植手术基础上,从一侧人工血管-一侧颈内动脉自体大隐静脉旁路移植术的A、B组均为5例.结果 所有患者手术均一次成功,成功率为100％,无死亡.出院时所有移植血管保持通畅,所有患者术后脑缺血症状均有不同程度改善.两组手术有效率均为100％,疗效比较差异无统计学意义(P＞0.05).手术并发症比较:A、B组中伸舌歪斜分别为5例与4例(P＞0.05),头昏分别为2例与9例(P＜0.05),头痛和眼胀均分别为2例与和7例(P＞0.05),脑出血分别为0例与2例(P＞0.05).全部患者都得到随访,随访时间3.5 ～13.5(8.5±2.0)年.症状复发:A、B组分别为2例与1例,两组的复发率比较差异无统计学意义(P＞0.05).结论 颈部动脉血流重建治疗由于大动脉炎导致的脑缺血是一种安全有效的方法,TCD术中监测可以明显降低术后过度灌注导致的并发症.“,”Objective To explore the effect of surgical bypass and the role of transcranial doppler (TCD) during the bypass operation.Methods A retrospective analysis was performed for the surgical data of cerebral ischemic Takayasu disease from January 2003 to December 2012 in single center.Forty one patients were divided into two groups:Group A with TCD during operation (n =22) and Group B without TCD (n =19).For group A,the main operation methods were 10 ascending aorta-biliteral axillary (brachial)/ subclavian artery artificial vascular graft bypass-unilateral internal carotid autologous great saphenous vein grafting,7 ascending aorta (aortic arch)-biliteral axillary (brachial)/subclavian artery artificial vascular bypass grafting,3 ascending aorta-unilateral subclavian and unilateral carotid artery artificial graft bypass,and 2 ascending aorta-unilateral internal carotid artery autogenous saphenous vein grafting.For group B,the corresponding number was 8,9,1,and 1 case,respectively.On the basis of above-mentioned ascending aorta-biliteral axillary artery graft,there were 5 artificial graft-unilateral internal carotid saphenous vein-grafting in both groups.Results All operations were successful with a success rate of 100％ and without death.All grafts remained patency when discharged,and all patients had improved cerebral ischemic symptoms.The effective rate of treatment was 100％ in both groups,without statistical significance between two groups (P ＞ 0.05).Complications were reversible tongue for 5 cases in group A and 4 in group B (P ＞ 0.05),dizziness for 2 cases in group A and 9 in group B (P ＜ 0.05),headache for 2 cases in each group (P ＞ 0.05),eye swelling for 7 cases in each group (P ＞ 0.05),and cerebral hemorrhage for 0 cases in group A and 2 in group B (P ＞ 0.05).All patients were followed-up 3.5 to 13.5 years,mean (8.5 ± 2.0) years.Symptom recurrence was 2 cases in group A and 1 in group B,and the recurrence rate of two groups had no difference (P ＞ 0.05).Conclusions Cervical arterial blood flow reconstruction is a safe and effective treatment for cerebral ischemia caused by Takayasu arteritis.TCD intraoperative monitoring can reduce postoperative complications caused by hyperperfusion significantly.