术中超声在侧脑室占位性病变的应用价值

Application value of intraoperative ultrasound in space-occupying lesions of lateral ventricle

目的探讨术中超声在侧脑室占位性病变的应用价值。方法选取江汉大学附属湖北省第三人民医院神经外科自2015年7月至2019年7月收治的28例侧脑室占位患者,手术切除前后及术中应用实时超声对病灶进行定位及定性诊断,指导临床医师选择合适手术路径,评价肿瘤切除程度。结果28例侧脑室占位病变患者中,边界不清晰10例(35.7%),病变周围存在水肿带12例(42.9%),病变内有血流信号14例(50%)。16例病理诊断WHO分级Ⅰ级肿瘤发现异常血流信号7例,12例病理诊断WHO分级Ⅰ级以上肿瘤发现异常血流信号10例,2组检出率比较差异有统计学意义(χ2=114.5,P=0.035)。术后1例死于早期术后再出血伴大面积脑梗死;27例患者术后半年随访,神经功能症状较术前均显著改善,无新发神经功能障碍。术后MRI复查显示病变全切25例,少量残留2例,术中超声定位引导下肿瘤全切率为92.59%。结论侧脑室占位切除术中,超声具有实时、便捷、图像直观、定位准确、可反复检查等独特优势,对于术中全切肿瘤,保护功能与血管具有重要帮助。

Objective To explore the application value of intraoperative ultrasound in lateral ventricle space occupying.Methods Twenty-eight patients with lateral ventricular space occupying lesions in the Neurosurgery Department of Third People’s Hospital Affiliated to Wuhan Jianghan University were selected from July 2015 to July 2019.All patients underwent localization and qualitative diagnosis by intraoperative ultrasonography before and after surgical resection,which guided clinicians to select appropriate surgical pathways and evaluated the extent of tumor resection.Results In 28 patients with lateral ventricular space occupying,10 cases(35.7%)had unclear boundary,12 cases(42.9%)had edema zone around lesions and 14 cases(50%)had blood flow signals in lesions.Abnormal blood flow signals were found in 7 cases of 16 patients with WHO gradeⅠand 10 cases of 12 patients with WHO grade aboveⅠ,and there was a significant difference in the detection rate between the two groups(χ2=114.5,P=0.035).One patient died of early postoperative because of rebleeding with massive cerebral infarction;27 patients were followed up for half a year,the neurological symptoms were significantly improved,and there was no new neurological dysfunction.Postoperative MRI reexamination showed total resection in 25 cases and minor residual in 2 cases.The overall complete resection rate guided by intraoperative ultrasound was 92.59%.Conclusion Intraoperative ultrasound has the advantages of real-time,convenience,visual image,accurate location and repeatable examination.It has unique advantages in lateral ventricle space-occupying surgery.It is helpful for full preoperative preparation,total resection of tumors,protection of function and blood vessels.