经颅多普勒超声对烟雾病患者脑硬脑膜动脉血管融通术疗效判定的研究

Study on effect evaluation of encephalo-duro-arterial synangiosias in patients with Moyamoya disease by transcranial Doppler sonography

目的探讨经颅多普勒超声(TCD)对烟雾病患者行脑硬脑膜动脉血管融通术(EDAS)前后颅内及颅外动脉血流变化的评估价值。方法对23例烟雾病患者行EDAS,并于手术前后行TCD检查,检测手术前后患者颞浅动脉的频谱形态及各项血流参数的变化,并与数字减影血管造影(DSA)结果进行比较。结果 TCD检测示术前患者的颞浅动脉呈典型颅外动脉频谱,频窗清晰;术后频谱明显颅内动脉化,血流速度明显增加,血供增加。术后患者颞浅动脉收缩期血流速度、舒张末期血流速度及平均血流速度较术前明显增加,搏动指数明显降低,差异有统计学意义(P﹤0.05)。术后复查DSA显示,良好13例,中等8例,差2例。复查TCD显示良好11例,中等7例,差3例,与DSA总符合率为86.95%(20/23)。结论 TCD能够准确检测烟雾病患者行EDAS前后颞浅动脉血流动力学的变化,可为其手术疗效的评估提供一定的客观依据。

Objective To evaluate the diagnostic value of transcranial Doppler sonography（TCD） used to detect the hemodynamic changes in the intracranial arteries and excranial arteries before and after the encephalo-duro-arterial synangiosias （EDAS） in the patients with Moyamoya disease. Methods Twenty-three patients with Moyamoya disease received TCD examination before and after EDAS. The hemodynamic changes in superficial temporal arteries （STA） were recorded. The hemodynamic parameters of STA of both preoperation and postoperation were compared with digital subtraction angiography. Results The spectrums of STA were the typical type of the excranial arteries,the spectrums of STA detected with TCD were similar to the intracranial arteries spectrums, mean velocity and pulsatility index of STA after the surgery were significantly higher than those before the surgery （P 〈 0.05 ）. The outcomes of the vascular reconstruction shown by TCD were consistent with that was shown by DSA in 23 patients （86.95%） after EDAS. Conclusion The hemodynamic changes in STA before and after EDAS can be detected noninvasively and easily by TCD,which can provide objective information for the assessment on the therapeutic effect of the EDAS for patients with Moyamoya disease.