本文選題：前交通動(dòng)脈瘤 + 微血管多普勒��； 參考：《福建醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：研究微血管多普勒(microvascular doppler ultrasonography,MDU)和吲哚菁綠熒光造影(indocyanine green video angiography，ICGA)聯(lián)合監(jiān)測(cè)在前交通動(dòng)脈瘤術(shù)中的應(yīng)用價(jià)值和意義。 方法：本文回顧分析了福建醫(yī)科大學(xué)附屬協(xié)和醫(yī)院神經(jīng)外科2011年1月至2013年1月收治的前交通動(dòng)脈瘤患者53例病例資料,術(shù)前所有病例均行CTA或DSA,治療手段采用經(jīng)翼點(diǎn)或改良翼點(diǎn)開顱動(dòng)脈瘤夾閉術(shù),術(shù)中采用MDU和ICGA聯(lián)合監(jiān)測(cè)，術(shù)后復(fù)查CTA或DSA，就此53例患者的術(shù)中監(jiān)測(cè)變化、術(shù)后影像學(xué)資料及預(yù)后進(jìn)行分析。 結(jié)果：53例前交通動(dòng)脈瘤患者均手術(shù)完全夾閉，一次性夾閉多發(fā)性動(dòng)脈瘤。MDU發(fā)現(xiàn)血流異常11例，其中7例動(dòng)脈血流增快，1例動(dòng)脈血流減弱，1例動(dòng)脈無血流，2例動(dòng)脈瘤夾閉不全，經(jīng)采取相應(yīng)的干預(yù)措施后，，8例血流恢復(fù)正常，1例仍無血流，2例瘤頸夾閉完全。2例夾閉后MDU示瘤體有血流，ICGA示造影劑外溢并瘤頸殘留，經(jīng)加用動(dòng)脈瘤夾后再次造影無造影劑外溢及瘤頸消失，夾閉滿意，出院時(shí)改良Rankin量表(modified Rankin scale，mRS)評(píng)分0分；1例MDU發(fā)現(xiàn)無血流，同時(shí)ICGA無顯影，干預(yù)后未恢復(fù)，術(shù)后多次復(fù)查頭顱CT示右額頂部出現(xiàn)低密度灶，出院時(shí)留有輕度神經(jīng)功能缺失，mRS評(píng)分2分。1例術(shù)中MDU和ICGA監(jiān)測(cè)未出現(xiàn)變化的患者，術(shù)后出現(xiàn)一過性偏癱，出院時(shí)mRS評(píng)分1分。51例患者恢復(fù)良好，未出現(xiàn)新的神經(jīng)功能缺失，出院時(shí)mRS評(píng)分0分。術(shù)后DSA或CTA復(fù)查示瘤頸夾閉完全。52例病人隨訪12-24個(gè)月，無再出血及死亡。 結(jié)論：在前交通動(dòng)脈瘤手術(shù)中，術(shù)中應(yīng)用MDU和ICGA聯(lián)合監(jiān)測(cè)可有效地提高動(dòng)脈瘤夾閉的完全性和成功率，同時(shí)可明確載瘤動(dòng)脈及其遠(yuǎn)端分支的通暢情況，兩者優(yōu)勢(shì)互補(bǔ)，從血流動(dòng)力學(xué)及形態(tài)學(xué)方面提高手術(shù)的安全性，最終實(shí)現(xiàn)改進(jìn)手術(shù)質(zhì)量，提高臨床療效。
[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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743

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