复合手术室在脑脊髓血管病治疗中的应用

发布时间：2018-04-28 18:19

本文选题：复合手术室 + 脑脊髓血管病　；参考：《大连医科大学》2015年硕士论文

【摘要】：目的:本文通过分析主要的影像学检查方法即数字减影脑血管造影(DSA)在术中脑脊髓血管病中的诊断及治疗中的优缺点及其对制订治疗方案的指导意义,探讨术中血管造影术在脑脊髓血管病的诊断及治疗中的临床应用价值,根据病人特点,包病情轻重、病变部位及经济因素等选择适宜的术前及术中检查方法,为临床实际工作提供一定参考。资料与方法:回顾性地分析我院神经外科从2014年1月至2014年12月同一手术组病人应用复合手术室治疗的情况,术前和(或)术中进行脑血管造影检查并明确诊断为脑脊髓血管病15例患者,脑血管造影分别诊断为:颅内动脉瘤9例,其中前交通动脉瘤1例、大脑中动脉瘤2例,后交通动脉瘤3例,颈内动脉眼动脉段动脉瘤1例,多发动脉瘤2例;按动脉瘤形态分类:囊状动脉瘤10个、梭形动脉瘤1个;以动脉瘤大小进行分类:巨大动脉瘤(25mm)1个,大动脉瘤(10~25mm)1个,中等动脉瘤(7~9mm)3个,小动脉瘤(4~6mm)5个,微小动脉瘤(3mm)1个,术前动脉瘤破裂出血所致的蛛网膜下腔出血的Hunt-Hess分级情况:Hunt-HessI级1例,II级5例,III级l例,IV级2例。脊髓硬脊膜动静脉瘘2例,延颈交界处髓周动静脉瘘1例,脑动静脉畸形2例,烟雾病1例。DSA采用德国西门子公司双C血管造影机,局麻下在下肢股动脉处穿刺行脑血管造影术,每根血管可行多角度照射及术中三位重建,直至病变观察理想为止。通过研究病人脑脊髓血管病变的造影影像学表现,进一步探讨病变血管的形态学特点与脑脊髓血管病变的发生、临床过程、治疗方式等的关系。结果:DSA检查显示:颅内动脉瘤共9例,其中1例为宽颈、巨大动脉瘤患者根据造影情况调整动脉瘤夹,保证载瘤动脉及穿支血管通畅情况下完全夹闭,2例为hunt-hess分级IV级动脉瘤患者直接由急诊进入复合手术室,造影及开颅手术同时进行,术中夹闭后再次造影多角度显示动脉瘤夹闭效果,保证载瘤动脉及穿支血管通畅情况下完全夹闭;2例脑动静脉畸形患者根据术中造影情况,精确定位、完整切除畸形血管团,术毕再次行脑血管造影显示血管畸形完全消失;1例烟雾病颞浅大脑中动脉架桥患者术中造影证实血管吻合通畅,术后复查头部CTA见吻合口通畅,颅外血运向颅内代偿;2例脊髓硬脊膜动静脉瘘术中造影定位,成功夹闭瘘口,夹闭后再次行血管造影提示动静脉瘘消失;1例延颈交界处髓周动静脉瘘术中造影定位,成功夹闭瘘口,夹闭后再次行血管造影提示髓周动静脉瘘消失。结论:DSA尤其是旋转DSA及三维重建技术可以明显提高脑脊髓血管病的检出率,可多角度立体观察,直观清晰地显示脑脊髓血管病变处的大小、形态、位置,为开颅手术治疗提供了准确的信息,术中血管造影即可评价脑脊髓血管病开颅手术治疗的效果,便于及时修正技术缺陷,降低术后并发症。
[Abstract]:Objective: to analyze the advantages and disadvantages of digital subtraction cerebrovascular angiography (DSAs) in the diagnosis and treatment of cerebral and spinal vascular disease during operation and its guiding significance in the formulation of treatment plan by analyzing the main imaging methods, I. E. digital subtraction angiography (DSAs), in the diagnosis and treatment of cerebral and spinal vascular diseases. To explore the clinical value of intraoperative angiography in the diagnosis and treatment of cerebral and spinal vascular disease, and to select appropriate preoperative and intraoperative examination methods according to the characteristics of the patient, the severity of the disease, the location of the lesion and economic factors. To provide some reference for clinical practice. Materials and methods: from January 2014 to December 2014, the patients in the same group of neurosurgery in our hospital were treated with compound operating room. Cerebrovascular angiography was performed before and / or during operation in 15 patients with cerebral and spinal angiopathy. Cerebral angiography was performed in 9 patients with intracranial aneurysms, including 1 anterior communicating artery aneurysm and 2 middle cerebral artery aneurysms. There were 3 cases of posterior communicating artery aneurysm, 1 case of internal carotid artery ophthalmic artery aneurysm, 2 cases of multiple aneurysm, 10 cases of cystic aneurysm and 1 case of fusiform aneurysm according to the shape of aneurysm, and 1 case according to the size of aneurysm: giant aneurysm (25 mm). There were 1 large aneurysm (10 ~ 25mm), 1 medium aneurysm (7mm), 3 small aneurysms (4mm), 5 microaneurysms (3mm). The Hunt-Hess classification of subarachnoid hemorrhage caused by rupture and hemorrhage of aneurysms: Hunt-HessI grade 1 case, grade II 5 cases, grade III 5 cases, grade IV 2 cases. Spinal dural arteriovenous fistula 2 cases, perimedullary arteriovenous fistula 1 case, cerebral arteriovenous malformation 2 cases, moyamoya disease 1 case. Cerebral angiography was performed on femoral artery of lower extremity under local anesthesia. Each vessel could be irradiated with multiple angles and reconstructed in three positions during operation until the pathological changes were observed satisfactorily. By studying the imaging findings of cerebral and spinal vascular lesions, the relationship between the morphological features of the diseased vessels and the occurrence, clinical process and treatment methods of cerebral and spinal cord vascular lesions was further discussed. Results of 9 patients with intracranial aneurysms, one was with wide neck, and the aneurysm clamp was adjusted according to the angiographic conditions in patients with giant aneurysms. Two cases of hunt-hess grade IV aneurysm were completely clipped under the condition of patency of aneurysm carrying artery and perforating branch. The patients entered the compound operating room directly from the emergency department. The angiography and craniotomy were performed at the same time. Two patients with cerebral arteriovenous malformation were completely clipped under the condition of patency of the aneurysm and perforating artery. According to the angiographic conditions, 2 patients with cerebral arteriovenous malformation were located accurately, and the malformed vessels were removed completely. After operation, another cerebral angiography was performed to show that the vascular malformation disappeared completely. In 1 case of moyamoya disease, the anastomosis of the middle temporal middle cerebral artery was confirmed by angiography during the operation, and the anastomosis of head CTA was found to be patency after operation. Two cases of spinal dural arteriovenous fistula were located by angiography during operation. After clipping, the arteriovenous fistula disappeared again, and 1 case of perimedullary arteriovenous fistula located at the junction of neck. The fistula was successfully clipped and angiography was performed again to indicate the disappearance of perimedullary arteriovenous fistula. Conclusion DSA, especially rotational DSA and 3D reconstruction can improve the detection rate of cerebral and spinal vascular diseases, and can be observed in different angles, and the size, shape and location of cerebral and spinal vascular lesions can be clearly and intuitively displayed. It provides accurate information for craniotomy. Intraoperative angiography can evaluate the effect of craniotomy for cerebral and spinal vascular disease, and it is convenient to correct the technical defects and reduce postoperative complications.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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