术中微血管超声多普勒在颅内动脉瘤夹闭术中的作用及疗效

Role and effect of intraoperative microvascular Doppler ultrasonography in intracranial aneurysm clipping operation

目的评价术中微血管超声多普勒(IMD)在开颅动脉瘤夹闭术中的作用和IMD对动脉瘤夹闭术患者的疗效。方法79例动脉瘤夹闭术患者术中于夹闭前、后采用IMD探测动脉瘤囊、分支血管及载瘤动脉的血流速度;并对比分析IMD对开颅动脉瘤夹闭术患者的疗效影响。结果 IMD发现大脑前动脉(ACA)、前交通动脉(ACoA)、大脑中动脉(MCA)动脉瘤患者以及复杂、巨大动脉瘤患者术中易出现因误夹或夹闭不全致载瘤动脉及分支血管血流速度改变而调整动脉瘤夹,另外术前Hunt-Hess分级越高的患者越容易出现误夹或夹闭不全;常规应用术中IMD探测的患者术后在住院日、再手术率、术后格拉斯哥昏迷(GOS)评分、并发症出现率等方面明显优于未行术中IMD探测的患者。结论开颅动脉瘤夹闭术中常规应用IMD有利于发现术中误夹或者夹闭不全,有利于及时调整动脉瘤夹位置,IMD辅助下的手术能明显改善患者术后GOS评分、缩短住院日、降低再手术率及并发症出现的概率。

Objective To evaluate the role and effect of intraoperative microvascular Doppler ultrasonography（IMD）in the in-tracranial aneurysm clipping operation.Methods The blood flow velocities of aneurysmal sac,adjacent vessels and parental arteries were determined by IMD before and after clipping in 79 cases of intracranial aneurysm clippings;the influence of IMD on the effect of craniotomy for intracranial aneurysm clipping was comparatively analyzed.Results IMD demonstrated that the clip adj ustment was more likely to happen in the patients with anterior intracranial artery（ACA）,anterior communication artery（ACoA）and middle intracranial artery（MCA）aneurysms,and the patients with complex,giant aneurysm due to the change of blood flow velocity in ad-jacent vessels and parental arteries caused by inadvertent occlusion or incomplete closure.In addition,the higher the preoperative Hunt-Hess classification,the easier the inadvertent occlusion or incomplete closur;the patients with conventional use of intraopera-tive IMD were significantly superior to those without intraoperative IMD in the aspects of the postoperative hospital stay,reopera-tion rate,postoperative GOS and complication occurence rate.Conclusion The routing use of IMD in the intracranial aneurysm clip-ping operation conduces to find the inadvertent occlusion or incomplete closure and the timely adj ust the aneurysm clip position;the IMD can assist operation can significantly improve the postoperative GOS score,short the hospital stay and reduce the reoperation rate and the probability of complication occurrence.