中文摘要：

目的探讨脑硬脑膜颞浅动脉血管融通术（EDAS）治疗出血型烟雾病的疗效及其影响因素。方法回顾性分析85例2002年12月—2011年12月在解放军第三。七医院行双侧EDAS治疗、术后采用DSA随访的出血型烟雾病患者的临床资料。分析项目包括性别、首次手术年龄，术前出血次数、脑代谢情况（正电子发射断层扫描，PET）评估、脑出血类型、是否合并脑缺血症状、烟雾病分期、大脑后动脉是否受累及是否有并发症（高血压、高血脂、高血糖任意一项），这些因素对血管重建效果的影响。结果①对85例（170侧大脑半球）术后6～43个月进行了随访，平均随访时间（13±8）个月。170侧大脑半球血管重建有效率为50．6％（86／170）。2例在随访期发生再出血，DSA显示颅外血管已向颅内大量代偿。②单因素分析显示，随着年龄的增大，EDAS的有效率逐渐降低（P=0．003）；出血前有缺血症状（P=0．0001）、术前脑代谢降低或缺损者（P=0．0001）及术前多次出血者（P=0．057）血管重建的效果更好。③多因素Logistic回归分析显示，高龄（OR=1．919，95％CI：1．163～3．167，P=0．011）是影响出血型烟雾病患者手术效果的独立危险因素，出血前有缺血症状（OR=0．252，95％CI：0．067～0．952，P=0．042）、脑代谢降低或缺损（OR=0．016，95％CI：0．004～0．060，P=0．000）是影响手术效果的保护性因素。结论年龄越低、出血前有缺血症状、脑代谢障碍者的血管重建效果更好。

英文摘要：

Objective To investigate the efficacy and its influencing factors of encephalo-duro-ar- terio-synangiosis （EDAS） in the treatment of hemorrhagic moyamoya disease. Methods The clinical da- ta of 85 patients with hemorrhagic moyamoya disease, who admitted to the 301st Hospital of PLA for bilater- al EDAS treatment and were followed up with DSA after procedure, were analyzed retrospectively. The effects of gender, age at first operation , preoperative bleeding frequency, cerebral glucose metabolism （positron emission tomography [ PET ] ） evaluation, types of intracerebral hemorrhage, having cerebral ischemic symptoms or not, stages of moyamoya disease, affecting posterior cerebral artery or not, having complications （ hypertension, heperlipemia or hyperglycaemia ） or not on the result of revascularization （ DSA evaluation）. Results （1）85 patients （ 170 sides） were followed up for 6 to 43 months by DSA after procedure. The mean follow-up time was 13 ± 8 months. The effective rate of revascularization of 170 hemispheres was 50.6% （86/170）. Two patients had rebleeding during the follow-up period. DSA showed that the extracranial vessels had large number of intracranial compensation. （2）Univariate analysis showed that the effective rate of EDAS decreased gradually with the increase of age （ P = 0. 003 ）. The efficacy of vascu- lar reconstruction was even better in patients who had ischemic symptoms before bleeding （ P = 0. 000 1 ） , preoperative reduced or defective brain metabolism （ P = 0. 000 1 ） and multiple attacks of bleeding before procedure （ P = 0. 057 ）. （3） Multivariate logistic regression analysis showed that advanced age （ OR = 1. 919, 95% CI 1. 163 to 3. 167 ;P = 0.011 ） was an independent risk factor for affecting the surgical effect in patients with hemorrhagic moyamoya disease. Having ischemic symptoms before bleeding （ OR = 0. 252, 95% CI O. 067 to O. 952 ; P = O. 042 ） and decreased or defects of cerebral metabolism （ OR = O. 016, 95%CI0.