超声在烟雾病颞浅动脉-大脑中动脉吻合术的应用研究

Ultrasonic evaluation of superficial temporal artery-middle cerebral artery anastomosis in moyamoya disease

目的探讨彩色多普勒超声评价烟雾病颞浅动脉-大脑中动脉吻合术手术疗效的应用价值。方法25例烟雾病颞浅动脉-大脑中动脉吻合术患者，手术前及术后1周探测双侧颈外动脉、颞浅动脉收缩期峰值流速（PSV）、舒张末期流速（EDV）、搏动指数（PI）及阻力指数（RI），并比较手术前后颈外动脉、颞浅动脉的血流参数变化情况。25例患者手术前及手术后1周行DSA检查，依据术后颞浅动脉向大脑中动脉分流程度分为大量、中等量及少量，比较不同组间颞浅动脉PSV、EDV、PI、RI。术后应用彩色多普勒超声沿手术切口追踪颞浅动脉全程，观察颞浅动脉血流方向及走行。结果①术后颈外动脉PSV、EDV较术前增快，PI、RI较术前降低，但差异无统计学意义。②术后颞浅动脉PSV、EDV较术前明显增快，PI、RI较术前显著减低。③术后DSA所示颞浅动脉向大脑中动脉分流量越大，颞浅动脉PSV、EDV越高，PI、RI越低。④术后彩色多普勒超声可追踪颞浅动脉全程，并在颞浅动脉入颅处探测到其血流方向由颅外流向颅内。结论彩色多普勒超声可以评价吻合血管通畅性及分流程度，且与DSA有做好的一致性，可作为无创性评价颞浅动脉-大脑中动脉吻合术手术疗效的方法。

Objective To evaluate the value of ultrasound in assessing superficial temporal arterymiddle cerebral artery（STA-MCA） anastomosis in patients with moyamoya disease. Methods Ultrasonic Doppler studies were made pre- and postoperatively in 25 patients with moyamoya disease undergoing STAMCA anastomosis. The peak systolic velocity （PSV）, end diastolic velocity （EDV）, pulsatility index （PI） and resistance index （RI） were measured in external carotidartery （ECA） and superficial temporal artery （STA） pre and postoperatively. The pattern of the collateral circulation through the bypass was categorized based on postoperative external carotid angiograms. Thus three categories were determined as extensive, moderate and poor. The patients were divided into three groups based on the pattern of the collateral circulation through the bypass, which was determined based on the angiographie findings. PSV, EDV, PI, RI of STA was compared between groups. Results （1）The values of the PSV,EDV of anastomosed STA were significantly higher and the values of PI, RI were significantly lower after operation. （2）The values of the PSV,EDV of the anastomosed ECA tended to be higher and the values of PI, RI tended to be lower in postoperation patients,but the differences were not significant within preoperation and postoperation group. （3）The values of the PSV,EDV of the anastomosed STA were significantly different among the groups. The PSV,EDV tended to be higher and the PI, RI tended to be lower in patients with more extensive bypass flow. （4）The blood flow direction of STA was from extracranial to intracranial. Conclusions The PSV, EDV,PI, RI of STA can predicting the extent of collateral flow through an STA-MCA bypass. Color Doppler ultrasonography is a noninvasive method of assessing the function of STA-MCA bypass in patients with moyamoya disease.