本文選題：復(fù)合手術(shù)室 + 腦脊髓血管病�。� 參考：《大連醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:本文通過(guò)分析主要的影像學(xué)檢查方法即數(shù)字減影腦血管造影(DSA)在術(shù)中腦脊髓血管病中的診斷及治療中的優(yōu)缺點(diǎn)及其對(duì)制訂治療方案的指導(dǎo)意義,探討術(shù)中血管造影術(shù)在腦脊髓血管病的診斷及治療中的臨床應(yīng)用價(jià)值,根據(jù)病人特點(diǎn),包病情輕重、病變部位及經(jīng)濟(jì)因素等選擇適宜的術(shù)前及術(shù)中檢查方法,為臨床實(shí)際工作提供一定參考。資料與方法:回顧性地分析我院神經(jīng)外科從2014年1月至2014年12月同一手術(shù)組病人應(yīng)用復(fù)合手術(shù)室治療的情況,術(shù)前和(或)術(shù)中進(jìn)行腦血管造影檢查并明確診斷為腦脊髓血管病15例患者,腦血管造影分別診斷為:顱內(nèi)動(dòng)脈瘤9例,其中前交通動(dòng)脈瘤1例、大腦中動(dòng)脈瘤2例,后交通動(dòng)脈瘤3例,頸內(nèi)動(dòng)脈眼動(dòng)脈段動(dòng)脈瘤1例,多發(fā)動(dòng)脈瘤2例;按動(dòng)脈瘤形態(tài)分類:囊狀動(dòng)脈瘤10個(gè)、梭形動(dòng)脈瘤1個(gè);以動(dòng)脈瘤大小進(jìn)行分類:巨大動(dòng)脈瘤(25mm)1個(gè),大動(dòng)脈瘤(10~25mm)1個(gè),中等動(dòng)脈瘤(7~9mm)3個(gè),小動(dòng)脈瘤(4~6mm)5個(gè),微小動(dòng)脈瘤(3mm)1個(gè),術(shù)前動(dòng)脈瘤破裂出血所致的蛛網(wǎng)膜下腔出血的Hunt-Hess分級(jí)情況:Hunt-HessI級(jí)1例,II級(jí)5例,III級(jí)l例,IV級(jí)2例。脊髓硬脊膜動(dòng)靜脈瘺2例,延頸交界處髓周動(dòng)靜脈瘺1例,腦動(dòng)靜脈畸形2例,煙霧病1例。DSA采用德國(guó)西門子公司雙C血管造影機(jī),局麻下在下肢股動(dòng)脈處穿刺行腦血管造影術(shù),每根血管可行多角度照射及術(shù)中三位重建,直至病變觀察理想為止。通過(guò)研究病人腦脊髓血管病變的造影影像學(xué)表現(xiàn),進(jìn)一步探討病變血管的形態(tài)學(xué)特點(diǎn)與腦脊髓血管病變的發(fā)生、臨床過(guò)程、治療方式等的關(guān)系。結(jié)果:DSA檢查顯示:顱內(nèi)動(dòng)脈瘤共9例,其中1例為寬頸、巨大動(dòng)脈瘤患者根據(jù)造影情況調(diào)整動(dòng)脈瘤夾,保證載瘤動(dòng)脈及穿支血管通暢情況下完全夾閉,2例為hunt-hess分級(jí)IV級(jí)動(dòng)脈瘤患者直接由急診進(jìn)入復(fù)合手術(shù)室,造影及開(kāi)顱手術(shù)同時(shí)進(jìn)行,術(shù)中夾閉后再次造影多角度顯示動(dòng)脈瘤夾閉效果,保證載瘤動(dòng)脈及穿支血管通暢情況下完全夾閉;2例腦動(dòng)靜脈畸形患者根據(jù)術(shù)中造影情況,精確定位、完整切除畸形血管團(tuán),術(shù)畢再次行腦血管造影顯示血管畸形完全消失;1例煙霧病顳淺大腦中動(dòng)脈架橋患者術(shù)中造影證實(shí)血管吻合通暢,術(shù)后復(fù)查頭部CTA見(jiàn)吻合口通暢,顱外血運(yùn)向顱內(nèi)代償;2例脊髓硬脊膜動(dòng)靜脈瘺術(shù)中造影定位,成功夾閉瘺口,夾閉后再次行血管造影提示動(dòng)靜脈瘺消失;1例延頸交界處髓周動(dòng)靜脈瘺術(shù)中造影定位,成功夾閉瘺口,夾閉后再次行血管造影提示髓周動(dòng)靜脈瘺消失。結(jié)論:DSA尤其是旋轉(zhuǎn)DSA及三維重建技術(shù)可以明顯提高腦脊髓血管病的檢出率,可多角度立體觀察,直觀清晰地顯示腦脊髓血管病變處的大小、形態(tài)、位置,為開(kāi)顱手術(shù)治療提供了準(zhǔn)確的信息,術(shù)中血管造影即可評(píng)價(jià)腦脊髓血管病開(kāi)顱手術(shù)治療的效果,便于及時(shí)修正技術(shù)缺陷,降低術(shù)后并發(fā)癥。
[Abstract]:Objective: to analyze the advantages and disadvantages of digital subtraction cerebrovascular angiography (DSAs) in the diagnosis and treatment of cerebral and spinal vascular disease during operation and its guiding significance in the formulation of treatment plan by analyzing the main imaging methods, I. E. digital subtraction angiography (DSAs), in the diagnosis and treatment of cerebral and spinal vascular diseases. To explore the clinical value of intraoperative angiography in the diagnosis and treatment of cerebral and spinal vascular disease, and to select appropriate preoperative and intraoperative examination methods according to the characteristics of the patient, the severity of the disease, the location of the lesion and economic factors. To provide some reference for clinical practice. Materials and methods: from January 2014 to December 2014, the patients in the same group of neurosurgery in our hospital were treated with compound operating room. Cerebrovascular angiography was performed before and / or during operation in 15 patients with cerebral and spinal angiopathy. Cerebral angiography was performed in 9 patients with intracranial aneurysms, including 1 anterior communicating artery aneurysm and 2 middle cerebral artery aneurysms. There were 3 cases of posterior communicating artery aneurysm, 1 case of internal carotid artery ophthalmic artery aneurysm, 2 cases of multiple aneurysm, 10 cases of cystic aneurysm and 1 case of fusiform aneurysm according to the shape of aneurysm, and 1 case according to the size of aneurysm: giant aneurysm (25 mm). There were 1 large aneurysm (10 ~ 25mm), 1 medium aneurysm (7mm), 3 small aneurysms (4mm), 5 microaneurysms (3mm). The Hunt-Hess classification of subarachnoid hemorrhage caused by rupture and hemorrhage of aneurysms: Hunt-HessI grade 1 case, grade II 5 cases, grade III 5 cases, grade IV 2 cases. Spinal dural arteriovenous fistula 2 cases, perimedullary arteriovenous fistula 1 case, cerebral arteriovenous malformation 2 cases, moyamoya disease 1 case. Cerebral angiography was performed on femoral artery of lower extremity under local anesthesia. Each vessel could be irradiated with multiple angles and reconstructed in three positions during operation until the pathological changes were observed satisfactorily. By studying the imaging findings of cerebral and spinal vascular lesions, the relationship between the morphological features of the diseased vessels and the occurrence, clinical process and treatment methods of cerebral and spinal cord vascular lesions was further discussed. Results of 9 patients with intracranial aneurysms, one was with wide neck, and the aneurysm clamp was adjusted according to the angiographic conditions in patients with giant aneurysms. Two cases of hunt-hess grade IV aneurysm were completely clipped under the condition of patency of aneurysm carrying artery and perforating branch. The patients entered the compound operating room directly from the emergency department. The angiography and craniotomy were performed at the same time. Two patients with cerebral arteriovenous malformation were completely clipped under the condition of patency of the aneurysm and perforating artery. According to the angiographic conditions, 2 patients with cerebral arteriovenous malformation were located accurately, and the malformed vessels were removed completely. After operation, another cerebral angiography was performed to show that the vascular malformation disappeared completely. In 1 case of moyamoya disease, the anastomosis of the middle temporal middle cerebral artery was confirmed by angiography during the operation, and the anastomosis of head CTA was found to be patency after operation. Two cases of spinal dural arteriovenous fistula were located by angiography during operation. After clipping, the arteriovenous fistula disappeared again, and 1 case of perimedullary arteriovenous fistula located at the junction of neck. The fistula was successfully clipped and angiography was performed again to indicate the disappearance of perimedullary arteriovenous fistula. Conclusion DSA, especially rotational DSA and 3D reconstruction can improve the detection rate of cerebral and spinal vascular diseases, and can be observed in different angles, and the size, shape and location of cerebral and spinal vascular lesions can be clearly and intuitively displayed. It provides accurate information for craniotomy. Intraoperative angiography can evaluate the effect of craniotomy for cerebral and spinal vascular disease, and it is convenient to correct the technical defects and reduce postoperative complications.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1

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