FLOW800技术在STA-MCA分流术治疗烟雾病效果评估中的作用

Evaluation of therapeutic effect of intra-extra cranial arterial bypass surgery on moyamoya disease by FLOW800 technique

目的探讨FLOW800技术在判断烟雾病颞浅动脉(STA)-大脑中动脉(MCA)分流术中血管吻合口通畅度及在手术治疗效果评估中的作用。方法回顾性分析2017年4月至2018年11月接STA-MCA分流术治疗的33例烟雾病的临床资料,手术前后应用FLOW800技术评估血管吻合口通畅情况及手术区域灌注改善情况。使用FLOW800软件对感兴趣区(ROI)进行分析,得到时间-荧光强度曲线,其中造影剂由动脉经循环后流至静脉的时间称为局部循环时间(MVTT),手术前后MVTT差值定义为ΔMVTT。结果33例均手术顺利,术中FLOW800分析均显示吻合口通畅。1因吻合口出现未行血管检查,其余32例吻合血管均通畅。术后11例发生并发症,其中低改善组6例(ΔMVTT<3 s),过改善组5例(ΔMVTT>3 s)。过改善组术前MVTT、ΔMVTT明显高于无并发症组和低改善组(P<0.05),而后两组均统计学差异(P>0.05)。受试者工作特征曲线分析结果显示ΔMVTT判断无并发症与低改善的最佳临界时间为1.635 s,敏感度和特异度分别为0.667和0.682;ΔMVTT判断无并发症与过改善的最佳临界时间为3.525 s,敏感度和特异度为别为1.000和0.727。结论FLOW800技术可准确评价烟雾病STA-MCA分流术中吻合口通畅程度,并在术后并发症的预测中起到一定的作用。

Objective To summarize the experience in evaluating therapeutic effects of intra-extra artery bypass surgery on moyamoya disease(MMD)by FLOW800 technique.Methods The clinical data of 33 patients with MMD,in whom the superficial temporal artery-middle cerebral artery bypass surgery were performed and the patency of the anastomotic site and the improvement of perfusion in the operative areas were assessed by FLOW800 technique before and after the surgery,were analyzed retrospectively.Results The bypass surgery was successfully performed in all the patients.The analysis with FLOW800 technique showed that the anastomotic site were unobstructed in all the patients.Bypass vessels were free in 32 patients.The postoperative complications occurred in 11 patients,and the other 22 patients recovered well.There was significant difference in preoperative local microvascular transit time and postoperative local microvascular trasit time(ΔMVTT)between 10 patients with postoperative complications and 22 patients without postoperative complications(P<0.05).The incidence of postoperative complications was lowest whenΔMVTT ranged from 1.635 seconds to 3.525 seconds.Conclusions FLOW800 has a convincing role in the evaluation of the patency of the blood vessel anastmosed by intraextra artery bypass surgery and it also plays a certain role in predicting the occurrence of complications after the bypass surgery in the patients with MMD,but the limitations of FLOW800 technique in practical clinical application are still considerable,and its role in neurosurgery is still to be further studied.