Dyna-CT在颅内支架成形术中的应用研究及评价
发布时间：2018-12-12 05:28
【摘要】：背景颅内动脉狭窄(ICAD)是缺血性脑卒中的首要致病因素,关于其治疗一直存在争议,虽然2014年1月发表的支架植入术和积极药物干预治疗颅内动脉狭窄患者卒中复发(Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis, SAMMPRIS)试验最终结果认为：通过药物治疗优于支架手术。然而许多研究者对该研究结果表示质疑,近期的多个单中心报道也表明：对已经给予双抗后仍出现缺血事件的患者行支架治疗是必要的。为进一步提高支架手术的疗效,要求医生更好地了解血管狭窄的细节情况、更准确地释放支架、更及时地发现并发症等,在传统造影系统上这是难以实现的要求。为解决以上难题,西门子公司2005年推出了数字平板造影机的C臂旋转并断层重建技术一-yna-CT技术。目前该技术在国内尚未广泛应用,因此有关其在颅内动脉狭窄支架成形术中应用的报道较少,有待研究。目的 总结颅内动脉狭窄患者支架成形时应用Dyna-CT的经验并评价其实用价值。方法 病例回顾性研究,将2007年3月至2013年6月在我院和长海医院(本人2014年在长海医院进修时获洪波教授同意参阅其患者病历资料)住院接受支架手术的颅内动脉狭窄患者共348例分成两组,A组179例在具备Dyna-CT功能的西门子造影机室手术,B组169例在不具备Dyna-CT功能的飞利浦造影机室治疗。对比两组病例以下指标：手术成功率、支架成形术耗时、手术并发症发生率、支架内再狭窄发生率((In Stent Restenosis, ISR)、对血管狭窄部位斑块的检出率、围手术期的改良Rankin量表(Modified Rankin Scale, mRS)评分差值。数据处理与分析使用SPSS 17.0统计软件,检验方法为独立样本t检验、卡方检验、非参数检验,以P0.05为差异具有统计学意义。结果 (1)通过预设病例选择标准本研究共纳入348例患者,7例手术未成功,其中A组4例,B组3例,手术成功率分别为A组97.8%(175/179),B组98.2%(166/169),两组手术成功率无差异(P0.05)；(2)以麻醉记录单为耗时依据,采用局麻-造影-全麻-支架置入的情况下耗时(分钟)分别为A组62.21±21.916,B组59.31±14.807,两组手术时间无差异(P0.05)。采用全麻-造影-支架置入术,耗时分别为A组99.88±23.454,B组99.82±21.475,两组手术时间无差异(P0.05)；(3)两组病例共发生21例严重神经系统相关并发症,其中术中出血8例,死亡4例；术中血栓形成5例,死亡1例；术后24～48小时内发生穿支血管梗死6例。并发症发生率分别为A组4.5%(8/179),B组7.7%(13/169),两组病例手术并发症发生率无差异(P0.05)；(4)支架内再狭窄发生率分别为A组15.40%(27/175),B组24.10%(40/166),两组的支架内再狭窄发生率有差异(P0.05)；(5)在血管狭窄部位共检出168个斑块,检出率49.2%,其中A组检出率为66.9%(117/175),B组30.7%(51/166),两组病例的血管狭窄部位斑块检出率有差异(P0.05)；(6)入院和出院时的mRS评分差值分别为A组0.41±1.193,B组0.40±0.953,两组无差异(P0.05)。结论 在颅内动脉狭窄支架成形术中应用Dyna-CT能更好了解狭窄部位细节,降低术后支架内再狭窄发生率,在症状性颅内动脉狭窄患者的介入治疗中具有实用价值。
[Abstract]:Background Intracranial Arterial Stenosis (ICAD) is the leading cause of ischemic stroke, and there has been a dispute over its treatment, although stent implantation and active drug intervention, published in January 2014, have been used to treat stroke recurrence in patients with intracranial arterial stenosis (Stenting and Aggressive Medical Management for Prev. The final result of the SAMMPRIS test was that the treatment was superior to the stent procedure by drug therapy. Many researchers, however, have questioned the results of the study, and several recent single-center reports have also shown that it is necessary to treat a patient with an ischemic event that has been treated with double-resistance. In order to further improve the curative effect of the stent, the surgeon is required to better understand the details of the vessel stenosis, to release the stent more accurately and to find the complications in a timely manner, which is difficult to achieve on the conventional contrast system. In order to solve the above problems, Siemens introduced the technology of C-arm rotation and fault reconstruction of the digital flat-plate-radiography machine in 2005. At present, the technology has not been widely used in the country, so the report about the application of the technology in the treatment of intracranial arterial stenosis is less and needs to be studied. Objective To summarize the experience of Dyna-CT in the treatment of intracranial arterial stenosis and to evaluate its value. Methods A retrospective study was conducted, and 348 cases of intracranial arterial stenosis who received stent operation from March 2007 to June 2013 in our hospital and Changhai Hospital (in 2014 at the Changhai Hospital in 2014) were divided into two groups. In group A, 179 patients were operated in a Siemens radiography room with Dyna-CT function, and 169 cases in group B were treated with a Philips radiography room without the function of Dyna-CT. The following indexes were compared between the two groups: the success rate of the operation, the time-consuming of stent-plasty, the rate of complications of the operation, the incidence of restenosis in the stent, and the modified Rankin Scale (mRS) score of the modified Rankin Scale (mRS) in the perioperative period. The data processing and analysis were SPSS 10.0. The test method was the independent sample t-test, the card-side test, the non-invasive test, and the difference was statistically significant with the difference of P0.05. Results (1) A total of 348 patients were included in the study through the pre-set case selection criteria. 7 cases were not successful. Among them, 4 of group A and 3 in group B, the success rate of operation was 97.8% (175/ 179) in group A and 98.2% in group B (166/ 169). The time-consuming (minutes) in the use of the local anesthesia-contrast-general anesthesia-stent placement was in group A, 62.21, 21.916, group B, 59.1, 147.807, and there was no difference between the two groups (P0.05). in group A, 99. 88, 23. 454, group B, 99. 82 and 21. 475, respectively, were used in group A, and there were no difference between the two groups (P0.05). (3) there were 21 serious neurological complications in both groups, including 8 cases of intraoperative hemorrhage and 4 cases of death; There were 5 cases of thrombosis in the operation, one in death, and 6 cases of vascular infarction in 24 to 48 hours after operation. The incidence of complication was 4. 5% (8/ 179) in group A and 7. 7% in group B (13/ 169). There was no difference in the incidence of complication in the two groups (P0.05). (4) The incidence of restenosis in the stent was 15.40% (27/ 175) in group A and 24.10% (40/ 166) in group B. (5) A total of 168 plaques were detected in the area of blood vessel stenosis. The detection rate was 42.2%. The detection rate of group A was 66. 9% (117/ 175) and that of group B was 30.7% (51/ 166). There was no difference between the two groups (P0.05). Conclusion The use of Dyna-CT in the treatment of intracranial arterial stenosis can better understand the details of the narrow part, reduce the incidence of restenosis after operation, and have practical value in the interventional treatment of the patients with symptomatic intracranial arterial stenosis.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R651.12
本文编号：2374005
[Abstract]:Background Intracranial Arterial Stenosis (ICAD) is the leading cause of ischemic stroke, and there has been a dispute over its treatment, although stent implantation and active drug intervention, published in January 2014, have been used to treat stroke recurrence in patients with intracranial arterial stenosis (Stenting and Aggressive Medical Management for Prev. The final result of the SAMMPRIS test was that the treatment was superior to the stent procedure by drug therapy. Many researchers, however, have questioned the results of the study, and several recent single-center reports have also shown that it is necessary to treat a patient with an ischemic event that has been treated with double-resistance. In order to further improve the curative effect of the stent, the surgeon is required to better understand the details of the vessel stenosis, to release the stent more accurately and to find the complications in a timely manner, which is difficult to achieve on the conventional contrast system. In order to solve the above problems, Siemens introduced the technology of C-arm rotation and fault reconstruction of the digital flat-plate-radiography machine in 2005. At present, the technology has not been widely used in the country, so the report about the application of the technology in the treatment of intracranial arterial stenosis is less and needs to be studied. Objective To summarize the experience of Dyna-CT in the treatment of intracranial arterial stenosis and to evaluate its value. Methods A retrospective study was conducted, and 348 cases of intracranial arterial stenosis who received stent operation from March 2007 to June 2013 in our hospital and Changhai Hospital (in 2014 at the Changhai Hospital in 2014) were divided into two groups. In group A, 179 patients were operated in a Siemens radiography room with Dyna-CT function, and 169 cases in group B were treated with a Philips radiography room without the function of Dyna-CT. The following indexes were compared between the two groups: the success rate of the operation, the time-consuming of stent-plasty, the rate of complications of the operation, the incidence of restenosis in the stent, and the modified Rankin Scale (mRS) score of the modified Rankin Scale (mRS) in the perioperative period. The data processing and analysis were SPSS 10.0. The test method was the independent sample t-test, the card-side test, the non-invasive test, and the difference was statistically significant with the difference of P0.05. Results (1) A total of 348 patients were included in the study through the pre-set case selection criteria. 7 cases were not successful. Among them, 4 of group A and 3 in group B, the success rate of operation was 97.8% (175/ 179) in group A and 98.2% in group B (166/ 169). The time-consuming (minutes) in the use of the local anesthesia-contrast-general anesthesia-stent placement was in group A, 62.21, 21.916, group B, 59.1, 147.807, and there was no difference between the two groups (P0.05). in group A, 99. 88, 23. 454, group B, 99. 82 and 21. 475, respectively, were used in group A, and there were no difference between the two groups (P0.05). (3) there were 21 serious neurological complications in both groups, including 8 cases of intraoperative hemorrhage and 4 cases of death; There were 5 cases of thrombosis in the operation, one in death, and 6 cases of vascular infarction in 24 to 48 hours after operation. The incidence of complication was 4. 5% (8/ 179) in group A and 7. 7% in group B (13/ 169). There was no difference in the incidence of complication in the two groups (P0.05). (4) The incidence of restenosis in the stent was 15.40% (27/ 175) in group A and 24.10% (40/ 166) in group B. (5) A total of 168 plaques were detected in the area of blood vessel stenosis. The detection rate was 42.2%. The detection rate of group A was 66. 9% (117/ 175) and that of group B was 30.7% (51/ 166). There was no difference between the two groups (P0.05). Conclusion The use of Dyna-CT in the treatment of intracranial arterial stenosis can better understand the details of the narrow part, reduce the incidence of restenosis after operation, and have practical value in the interventional treatment of the patients with symptomatic intracranial arterial stenosis.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R651.12
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