术中吲哚菁绿荧光血管造影和FLOW 800技术在神经血管外科手术中的初步应用研究

发布时间：2018-06-10 06:34

本文选题：吲哚菁绿 + FLOW　；参考：《中国人民解放军医学院》2015年博士论文

【摘要】：目的：研究旨在报道近年来本单位在神经血管手术中应用吲哚菁绿(indocyanine green videoangiography, ICG)荧光造影及FLOW 800支术的初步经验,并通过在颅内动脉瘤手术中将其与微血管多普勒超声(1microvascular Doppler sonography,mDs)以及术后脑血管造影(digital subtraction angiography, DS A)结果进行对比,评价这一新技术的效能。在脑动静脉畸形(arteriovenous malformation, AVM)分步切除手术中,我们对其用于血流动态及脑灌注定量评估的有效性进行评价。方法：第一部分,我们将术中FLOW 800和微血管多普勒超声所有发现分别记录,并将结果与术后DSA进行比较验证。对于术中FLOW 800发现与术后DSA结果不符者,我们单独记录,用于后续分析使用。通过对FLOW800和术后DSA结果比较,我们对FLOW 800诊断准确性进行评价。而FLOW 800与术后DSA结果不符者,我们用于进一步预测造成这一差异的风险因素。为了对FLOW800定量分析功能进行评价,我们将其特异性血流测量结果与微血管多普勒超声结果进行对比,分析两者相关性。第二部分,我们分别于术中AVM切除前、供血动脉阻断后以及AVM切除后三个时期分别行ICG造影和FLOW 800分析。我们将“彩色地图”功能用于高分辨观察血管结构以及快速判断血流动态。我们将FLOW 800特异性血流参数,包括“最大强度”、“延迟时间”、“通过时间”和“脑血流指数”用于记录AVM(供血动脉,畸形血管团及引流静脉)及其邻近和远隔脑组织(动脉和脑皮质)血流动力学改变,并用于局部血流动态和脑灌注的实时测量评估。结果：第一部分,我们对25位患者共31例颅内动脉瘤成功进行了术中ICG造影和FLOW 800后续分析以及微血管多普勒超声检查。其中,FLOW 800与术后DSA结果符合率为80.1%(25 of 31),而微血管多普勒超声与术后DSA结果符合率为77.4%(24 of 31)。统计学分析显示,FLOW 800与术后DSA用于颅内动脉瘤手术效果诊断评价相关性良好p=0.0033),且两种方法无显著差异p=0.2888,correlated X2=1.1250)。而对FLOW 800与术后DSA结果不符者的进一步分析,结果并未发现明确的差异预测因素。在对FLOW 800定量分析功能进行评价的结果中我们发现,FLOW 800特异性血流测量结果与微血管多普勒超声结果两者无明显相关性(P0.05)。第二部分,FLOW 800“彩色地图”帮助有效辨认并完全切除AVM10例,结果被术后DSA证实。另一例患者因畸形血管团位置深在,术中无法通过ICG造影和FLOW 800发现而利用多模态导航实现病变完全切除。在FLOW800特异性血流分析结果中,病变邻近脑皮层血流“通过时间”在AVM切除后明显较术前缩短(p0.01),而病变远隔皮层血流手术前后无显著变化(p0.05)。其它血流参数如“最大荧光强度”和“脑血流指数”等,在各时期均未发现显著改变。结论：总之,ICG荧光造影及FLOW 800技术在神经血管手术中用于术中血流动态评估快速、有效。该技术可进一步提高手术安全性及术者信心。 “彩色地图”功能可用于高分辨观察血管结构以及快速判断血流动态,并在AVM手术中效果尤为显著。FLOW 800特异性血流分析可在一定程度上提供更多的血流灌注信息。然而,将其单独用于脑血流测量,结果并不可靠。
[Abstract]:Objective: the purpose of this study was to report on the preliminary experience of indocyanine green videoangiography (ICG) fluorescein and FLOW 800 branches in neurovascular surgery in recent years, and to use the microvascular Doppler ultrasonography (1microvascular Doppler sonography, mDs) and cerebral blood in the operation of intracranial aneurysms. The results of digital subtraction angiography (DS A) were compared to evaluate the effectiveness of this new technique. In the stepwise resection of the arteriovenous malformation (AVM), we evaluated the effectiveness of its quantitative assessment of blood flow and cerebral perfusion. Method: in the first part, we will make FLOW 800 in the operation. All the findings were recorded with the microvascular Doppler ultrasound, and the results were compared with the postoperative DSA. For the FLOW 800 in the operation, we recorded separately and used for subsequent analysis. We evaluated the accuracy of the FLOW 800 by comparing the FLOW800 and postoperative DSA results. And FLOW 800 and postoperatively. We used to further predict the risk factors for this difference. In order to evaluate the FLOW800 quantitative analysis, we compared the results of the specific blood flow measurement with the results of the microvascular Doppler ultrasound and analyzed the two correlation. Second, we divided the blood supply artery before AVM resection. After three periods after AVM resection, ICG and FLOW 800 were performed respectively. We used the "color map" function to observe the vascular structure and quickly determine the blood flow dynamics. We used the FLOW 800 specific blood flow parameters, including "maximum strength", "delay time", "through time" and "cerebral blood flow index". The hemodynamic changes of AVM (blood supply artery, malformed vessel and drainage vein) and adjacent and distant brain tissues (arteries and cerebral cortex) were recorded and used for real-time measurement of local blood flow and cerebral perfusion. Results: Part 1, we performed 31 cases of intracranial aneurysms in 25 patients followed by intraoperative ICG and FLOW 800. Analysis and microvascular Doppler ultrasonography. Among them, the coincidence rate of FLOW 800 and postoperative DSA was 80.1% (25 of 31), while the coincidence rate of microvascular Doppler ultrasound and postoperative DSA was 77.4% (24 of 31). Statistical analysis showed that FLOW 800 and postoperative DSA used for intracranial aneurysm operation diagnostic evaluation were good p=0.0033), and two species were found. There was no significant difference in p=0.2888, correlated X2=1.1250). The further analysis of FLOW 800 and postoperative DSA results did not find a clear difference predictor. In the evaluation of the quantitative analysis of FLOW 800, we found that the specific blood flow measurement results of FLOW 800 and the results of microvascular Doppler ultrasound were two. There was no significant correlation (P0.05). The second part, FLOW 800 "color map" helped to identify and completely remove AVM10 cases. The result was confirmed by DSA after operation. The other patient was unable to use multimodal navigation through ICG contrast and FLOW 800 to realize complete resection of the lesions. In FLOW800 specific blood flow. In the analysis, the "passing time" of the adjacent cerebral cortex was significantly shorter after AVM resection than before the operation (P0.01), but there was no significant change before and after the operation (P0.05). Other blood flow parameters, such as "maximum fluorescence intensity" and "cerebral blood flow index", were not significantly changed at all times. Conclusion: in a word, ICG fluore The technique of radiography and FLOW 800 is fast and effective in the evaluation of blood flow in the operation of neurovascular surgery. This technique can further improve the safety of the operation and the confidence of the operator. "Color map" function can be used for high resolution observation of vascular structure and rapid determination of blood flow dynamics, and the effect of AVM operation is particularly significant for the specificity of.FLOW. Blood flow analysis can provide more blood perfusion information to some extent. However, it is not reliable to use it alone in cerebral blood flow measurement.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R651

【相似文献】