经颅多普勒超声在颞浅动脉-大脑中动脉搭桥术中的应用价值

Application value of TCD in superficial temporal artery-middle cerebral artery bypass surgery

目的应用经颅多普勒超声(TCD)-16M超高频探头观察颞浅动脉-大脑中动脉(STA-MCA)搭桥术中大脑中动脉(MCA)及颞浅动脉(STA)血流动力学的变化。方法回顾性纳入2015年6月至2019年1月经头颈部CT血管造影(CTA)确诊颈内动脉(ICA)颅内段或MCA主干闭塞造成MCA远端供血障碍的31例烟雾病患者,行STA - MCA搭桥术,并应用TCD - 16M探头实时监测搭桥前后MCA(M4段)及术后STA血流动力学变化,从而判断吻合口及搭桥血管通畅情况。结果31例患者术前MCA血流频谱均呈低流速低阻力血流信号改变,STA血流频谱呈"高阻型",STA - MCA搭桥术后MCA远心段及近心段血流速度明显增快,差异有统计学意义(P<0.05),阻力指数(RI)稍增高,但差异无统计学意义(P>0.05),术后STA血流速度明显增快,RI降低,差异有统计学意义(P <0.05)。结论TCD可实时有效地监测STA - MCA搭桥术中MCA及STA血流动力学变化,为判断吻合口及搭桥血管通畅性提供依据。

Objective The hemodynamic changes of middle cerebral artery (MCA) and superficial temporal artery (STA) during superficial temporal artery - middle cerebral artery ( STA - MCA) bypass were observed by transcranial Doppler ultrasound (TCD)- 16M ultrahigh frequency probe. Mediods From June 2015 to January 2019, 31 patients with moyamoya disease whose internal carotid artery (ICA) occlusion or MCA trunk occlusion affected distal MCA blood supply disorder were retrospectively included by DSA or CTA, STA - MCA bypass was performed, TCD - 16M probe was used to monitor the changes of MCA blood flow before and after bypass and STA blood flow after bypass, so as to judge the patency of anastomotic stoma and bypass vessels. Results The blood flow spectrum of 31 patients showed low flow and low resistance before operation, and the blood flow spectrum of STA was " high resistance". After MCA - STA bypass ,the blood flow velocity of distal and proximal segments of MCA increased significantly (P<0.05), and the resistance index (RI)increased slightly, but there was no significant difference between the two groups (P >0.05). The blood flow velocity of STA increased significantly after MCA - STA bypass, while the RI decreased (P <0. 05). Conclusions TCD can effectively monitor the changes of MCA and STA blood flow in real time during operation, and provide favorable evidence for judging the patency of anastomotic and bypass vessels.