微血管多普勒和吲哚菁绿荧光造影联合监测在前交通动脉瘤术中的应用研究

发布时间：2018-05-25 19:55

本文选题：前交通动脉瘤 + 微血管多普勒　；参考：《福建医科大学》2014年硕士论文

【摘要】：目的：研究微血管多普勒(microvascular doppler ultrasonography,MDU)和吲哚菁绿荧光造影(indocyanine green video angiography，ICGA)联合监测在前交通动脉瘤术中的应用价值和意义。方法：本文回顾分析了福建医科大学附属协和医院神经外科2011年1月至2013年1月收治的前交通动脉瘤患者53例病例资料,术前所有病例均行CTA或DSA,治疗手段采用经翼点或改良翼点开颅动脉瘤夹闭术,术中采用MDU和ICGA联合监测，术后复查CTA或DSA，就此53例患者的术中监测变化、术后影像学资料及预后进行分析。结果：53例前交通动脉瘤患者均手术完全夹闭，一次性夹闭多发性动脉瘤。MDU发现血流异常11例，其中7例动脉血流增快，1例动脉血流减弱，1例动脉无血流，2例动脉瘤夹闭不全，经采取相应的干预措施后，，8例血流恢复正常，1例仍无血流，2例瘤颈夹闭完全。2例夹闭后MDU示瘤体有血流，ICGA示造影剂外溢并瘤颈残留，经加用动脉瘤夹后再次造影无造影剂外溢及瘤颈消失，夹闭满意，出院时改良Rankin量表(modified Rankin scale，mRS)评分0分；1例MDU发现无血流，同时ICGA无显影，干预后未恢复，术后多次复查头颅CT示右额顶部出现低密度灶，出院时留有轻度神经功能缺失，mRS评分2分。1例术中MDU和ICGA监测未出现变化的患者，术后出现一过性偏瘫，出院时mRS评分1分。51例患者恢复良好，未出现新的神经功能缺失，出院时mRS评分0分。术后DSA或CTA复查示瘤颈夹闭完全。52例病人随访12-24个月，无再出血及死亡。结论：在前交通动脉瘤手术中，术中应用MDU和ICGA联合监测可有效地提高动脉瘤夹闭的完全性和成功率，同时可明确载瘤动脉及其远端分支的通畅情况，两者优势互补，从血流动力学及形态学方面提高手术的安全性，最终实现改进手术质量，提高临床疗效。
[Abstract]:Objective: to study the value and significance of microvascular doppler ultrasonography (MDU) and indocyanine green video angiography (ICGA) in anterior communicating aneurysm. Methods: the data of 53 cases of anterior communicating aneurysm admitted from January 2011 to January 2013 in the Union Hospital of Fujian Medical University were retrospectively analyzed. All patients were treated with CTA or DSA.Transpterional or modified pterygotomy was used to treat aneurysm, MDU and ICGA were used to monitor the aneurysm. Postoperative imaging data and prognosis were analyzed. Results all 53 cases of anterior communicating artery aneurysm were completely clipped by operation. 11 cases were found to have abnormal blood flow by one time clipping of multiple aneurysms. Among them, 7 cases had rapid increase of arterial blood flow, 1 case had decreased arterial blood flow, 1 case had no blood flow, 2 cases had aneurysm clipping insufficiency. After corresponding intervention, 1 case had normal blood flow, 1 case had no blood flow, 2 cases had tumor neck occlusion, 2 cases had tumor neck clipping, MDU showed that there was blood flow in the tumor body, which showed that the contrast agent overflow and the tumor neck remained. After adding aneurysm clip, no contrast media overflow and tumor neck disappeared again. The clipping was satisfactory. On discharge, the modified Rankin scale was scored 0 and no blood flow was found in 1 case of MDU. Meanwhile, no blood flow was found in 1 case of MDU, and no development of ICGA was found, which did not recover after intervention. The CT findings of the right forehead showed a low density focus on the right frontalis many times after operation. There were 2 points of mild neurological deficit and mRS score of 2. 1 patients who had no changes in MDU and ICGA monitoring during operation. Transient hemiplegia occurred after operation. The mRS score was 1. 51 patients recovered well and no new neurological function was found. The mRS score was 0 at the time of discharge. Postoperative DSA or CTA examination showed complete cervical clipping. 52 patients were followed up for 12 to 24 months. No further bleeding or death was found. Conclusion: combined monitoring of MDU and ICGA during anterior communicating aneurysm operation can effectively improve the completeness and success rate of aneurysm clipping, at the same time, the patency of the aneurysm carrying artery and its distal branches can be determined. The two advantages complement each other. The safety of the operation was improved from the aspects of hemodynamics and morphology, and the operation quality was improved and the clinical curative effect was improved.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743

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