Long-Term Outcomes of Indirect Bypass for 629 Children With Moyamoya Disease Longitudinal and Cross-Sectional Analysis
Long-Term Outcomes of Indirect Bypass for 629 Children With Moyamoya Disease Longitudinal and Cross-Sectional Analysis
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DOI：
10.1161/strokeaha.119.025609
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发表时间：
2019-11-01
期刊：
影响因子：
8.3
通讯作者：
Kim, Seung-Ki
中科院分区：
文献类型：
--
作者：
Ha, Eun Jin;Kim, Kyung Hyun;Kim, Seung-Ki
背景和目的：在儿童烟雾病中，很少有关于手术干预预防卒中的报道。我们在一个中心评估了间接搭桥手术对相对大量的烟雾病患儿的长期疗效。方法：从1988年8月至2012年12月，772名儿童接受了间接旁路手术。该研究包括629例随访>5年的患者，不包括烟雾综合征患者。平均临床随访时间为12年（范围：5-29年）。基于Karnofsky表现量表或Lansky游戏表现量表进行横断面分析，以评估总体临床结局和与不良结局相关的因素。为了分析手术的纵向效应，采用人-年法计算间接旁路手术后手术半球症状性梗死或出血的年风险，并采用Kaplan-Meier方法评估无事件生存率。结果：95%的患者的总体临床结局良好。手术半球出现症状性梗死和出血的年风险分别为0.08%和0.04%。此外，症状性梗死和出血的10年无事件生存率分别为99.2%和99.8%。结论：间接搭桥手术可以提供令人满意的长期改善总体临床结果和预防儿童烟雾病卒中复发。
Background and Purpose- In pediatric moyamoya disease, there are few reports on the efficacy of surgical intervention for stroke prevention. We evaluated the long-term outcomes of indirect bypass surgery on a relatively large number of children with moyamoya disease in a single center. Methods- From August 1988 to December 2012, 772 children underwent indirect bypass surgery. This study included 629 patients who were followed up for >5 years, excluding patients with moyamoya syndrome. The mean clinical follow-up duration was 12 years (range, 5-29 years). Cross-sectional analysis was performed based on either Karnofsky Performance Scale or Lansky Play Performance Scale to evaluate overall clinical outcomes and factors associated with unfavorable outcomes. To analyze the longitudinal effect of surgery, the annual risk of symptomatic infarction or hemorrhage on the operated hemisphere after indirect bypass surgery was calculated with a person-year method, and the event-free survival rate was evaluated using the Kaplan-Meier method. Results- The overall clinical outcome was favorable in 95% of the patients. The annual risks of symptomatic infarction and hemorrhage on the operated hemispheres were 0.08% and 0.04%, respectively. Furthermore, the 10-year event-free survival rates for symptomatic infarction and hemorrhage were 99.2% and 99.8%. Conclusions- Indirect bypass surgery could provide satisfactory long-term improvement in overall clinical outcome and prevention of recurrent stroke in children with moyamoya disease.