术中超声在颅内海绵状血管瘤显微外科切除中的应用

发布时间：2019-06-25 13:30

【摘要】：[目的]探讨术中超声在颅内海绵状血管瘤显微外科切除中的应用。[方法]回顾性分析2014年11月至2016年9月昆明医科大学第一附属医院神经外科手术治疗25例颅内海绵状血管瘤患者的临床资料,所有患者应用术中超声进行病变定位,并在术中超声的实时辅助下切除病变,判断病变的切除程度。术后观察患者病变切除率、神经系统功能恢复及并发症发生率等情况。[结果]本组25例颅内海绵状血管瘤患者术中超声均能对病变显示良好,定位准确。所有患者在术中超声辅助下均完全切除病变,病变全切率为100%,无术中超声扫描导致的脑挫裂伤、出血等并发症,无感染、死亡病例,术后病理结果均为海绵状血管瘤。术后25例患者临床症状、体征均较前明显好转,无出现新的神经功能障碍。10例头疼患者症状基本消失,4例神经功能障碍患者均完全恢复正常,11例癫痫患者中,9例已完全治愈,无需口服抗癫痫药物,2例口服抗癫痫药物可完全控制。复查头颅MRI均未见病变复发。[结论]术中超声是一种安全的、非放射性的成像技术,使用简便,操作灵活。术中超声可清晰显示颅内海绵状血管瘤的形态学和解剖学细节及其与毗邻结构的空间关系,可对颅内海绵状血管瘤进行准确的定位和判定边界,为术者选择皮层探查切口、显微切除肿瘤及判断肿瘤残留等方面提供了有价值的信息,协助和引导手术进程,从而大大增加了肿瘤切除率,减少脑组织损伤,缩短手术时间,提高手术治疗效果。随着更小、更精确的超声探头与三维超声、超声造影、彩色多普勒血流成像等技术有效地结合,术中超声对判断肿瘤边界、血流供应等方面取得较大进步,具有广阔的临床应用前景和价值。
[Abstract]:Objective to explore the application of intraoperative ultrasound in microsurgical resection of intracranial cavernous angioma. [methods] the clinical data of 25 patients with intracranial cavernous angioma treated by neurosurgery in the first affiliated Hospital of Kunming Medical University from November 2014 to September 2016 were analyzed retrospectively. all patients were located by intraoperative ultrasound and resected with the real-time assistance of intraoperative ultrasound to judge the degree of resection. After operation, the resection rate of lesion, the recovery of nervous system function and the incidence of complications were observed. [results] Intraoperative ultrasound could display the lesions well and locate accurately in 25 patients with intracranial cavernous angioma. All the patients were completely resected with the assistance of intraoperative ultrasound, and the total resection rate was 100%. There were no complications such as cerebral contusion and laceration and hemorrhage caused by intraoperative ultrasound scan, no infection, death and postoperative pathological results were cavernous angiomas. The clinical symptoms and signs of 25 patients were significantly improved after operation, and there was no new neurological dysfunction. The symptoms of 10 patients with headache basically disappeared, 4 patients with neurological dysfunction completely returned to normal. Among the 11 epileptic patients, 9 cases were completely cured, no oral antiepileptic drugs were needed, and 2 cases were completely controlled by oral antiepileptic drugs. No recurrence of lesions was found on MRI. [conclusion] Intraoperative ultrasound is a safe and non-radioactive imaging technique, which is simple to use and flexible to operate. Intraoperative ultrasound can clearly display the morphological and anatomical details of intracranial cavernous angioma and its spatial relationship with adjacent structures, accurately locate and determine the boundary of intracranial cavernous angioma, provide valuable information for operators to select cortical exploration incision, microscopic resection of tumor and judge tumor residue, assist and guide the surgical process, thus greatly increasing tumor resection rate and reducing brain tissue injury. Shorten the operation time and improve the effect of operation. With the effective combination of smaller and more accurate ultrasound probe with three-dimensional ultrasound, contrast-enhanced ultrasound and color Doppler flow imaging, intraoperative ultrasound has made great progress in judging tumor boundary and blood flow supply, which has broad clinical application prospect and value.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12

【参考文献】