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浙江大学学报（医学版）
浙江大学学报（医学版）  2019, Vol. 48 Issue (3): 233-240    DOI: 10.3785/j.issn.1008-9292.2019.06.01
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缺血性脑血管疾病手术治疗新进展
张建民()
浙江大学医学院附属第二医院神经外科, 浙江 杭州 310009
Advances in surgical treatment of ischemic cerebrovascular disease
ZHANG Jianmin()
Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
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摘要：

恢复脑组织血流供应是缺血性脑血管疾病治疗的关键。手术治疗在缺血性脑血管疾病的治疗中有着重要作用。机械取栓术能使急性闭塞的颅内大血管迅速而有效地开通，最大可能挽救低灌注区域缺血脑组织的血供；去骨瓣减压术作为治疗大面积脑梗死的常规备选方案，手术时机的选择是决定疗效的重要因素；颈动脉内膜切除术作为预防缺血性脑卒中的重要手段，个体化手术方案的选择有助于提高手术的疗效和安全性；对于烟雾病实施脑血流重建术，精准的临床和影像学评估、合理的手术方案制订和准确的术中判断是保证手术效果的关键；复合手术适合处理颅内/外血管长节段狭窄和（或）慢性闭塞等复杂性缺血性脑血管疾病。本文围绕上述常见的缺血性脑血管疾病的手术治疗及临床应用新进展进行阐述。
关键词： 脑缺血/治疗;  外科手术/方法;  颈动脉内膜切除术;  卒中;  综合疗法;  综述    
Abstract:

Restoration of cerebral blood flow is particularly important for the treatment of ischemic cerebrovascular disease. It is notable that surgical approaches play a unique role in treating this devastating disease. Among them, mechanical thrombectomy facilitates rapid and effective recanalization of occluded intracranial large vessels causing ischemic stroke, which contributes to improvement of cerebral perfusion in the ischemic penumbra; decompressive craniectomy is an important therapeutic option for acute massive cerebral infarction, and the timing of surgery determines the final clinical outcomes; for carotid endarterectomy in carotid-artery stenosis, individualized surgical plan is important for the safety and effectiveness of the operation; in the surgical revascularization of Moyamoya disease, precise evaluation of clinical and radiological characteristics, optimal surgical strategies and accuracy of intraoperative judgment will yield maximal therapeutic effects; and hybrid surgery is feasible for the therapy of complex ischemic cerebrovascular diseases, such as extracranial/intracranial arteries tandem stenosis and symptomatic chronic total occlusion of carotid artery. This paper reviews recent technical and clinical advances in the surgical treatment of ischemic cerebrovascular disease.
Key words: Brain ischemia/therapy    Surgical procedures, operative/methods    Endarterectomy, carotid    Stroke    Combined modality therapy    Review
收稿日期: 2019-06-01 出版日期: 2019-09-04
CLC:  R743  
基金资助: 浙江省重点研发计划(2017C03021)
作者简介: 张建民(1959-), 男, 博士, 主任医师, 教授, 博士生导师, 主要从事脑卒中的基础和临床研究; E-mail:zjm135@vip.sina.com; https://orcid.org/0000-0003-1878-8388
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引用本文:

张建民. 缺血性脑血管疾病手术治疗新进展[J]. 浙江大学学报（医学版）, 2019, 48(3): 233-240.

ZHANG Jianmin. Advances in surgical treatment of ischemic cerebrovascular disease. J Zhejiang Univ (Med Sci), 2019, 48(3): 233-240.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.06.01    或    http://www.zjujournals.com/med/CN/Y2019/V48/I3/233

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