本文選題：吲哚菁綠 + FLOW　； 參考：《中國人民解放軍醫(yī)學(xué)院》2015年博士論文

【摘要】：目的：研究旨在報道近年來本單位在神經(jīng)血管手術(shù)中應(yīng)用吲哚菁綠(indocyanine green videoangiography, ICG)熒光造影及FLOW 800支術(shù)的初步經(jīng)驗,并通過在顱內(nèi)動脈瘤手術(shù)中將其與微血管多普勒超聲(1microvascular Doppler sonography,mDs)以及術(shù)后腦血管造影(digital subtraction angiography, DS A)結(jié)果進行對比,評價這一新技術(shù)的效能。在腦動靜脈畸形(arteriovenous malformation, AVM)分步切除手術(shù)中,我們對其用于血流動態(tài)及腦灌注定量評估的有效性進行評價。方法：第一部分,我們將術(shù)中FLOW 800和微血管多普勒超聲所有發(fā)現(xiàn)分別記錄,并將結(jié)果與術(shù)后DSA進行比較驗證。對于術(shù)中FLOW 800發(fā)現(xiàn)與術(shù)后DSA結(jié)果不符者,我們單獨記錄,用于后續(xù)分析使用。通過對FLOW800和術(shù)后DSA結(jié)果比較,我們對FLOW 800診斷準確性進行評價。而FLOW 800與術(shù)后DSA結(jié)果不符者,我們用于進一步預(yù)測造成這一差異的風(fēng)險因素。為了對FLOW800定量分析功能進行評價,我們將其特異性血流測量結(jié)果與微血管多普勒超聲結(jié)果進行對比,分析兩者相關(guān)性。第二部分,我們分別于術(shù)中AVM切除前、供血動脈阻斷后以及AVM切除后三個時期分別行ICG造影和FLOW 800分析。我們將“彩色地圖”功能用于高分辨觀察血管結(jié)構(gòu)以及快速判斷血流動態(tài)。我們將FLOW 800特異性血流參數(shù),包括“最大強度”、“延遲時間”、“通過時間”和“腦血流指數(shù)”用于記錄AVM(供血動脈,畸形血管團及引流靜脈)及其鄰近和遠隔腦組織(動脈和腦皮質(zhì))血流動力學(xué)改變,并用于局部血流動態(tài)和腦灌注的實時測量評估。結(jié)果：第一部分,我們對25位患者共31例顱內(nèi)動脈瘤成功進行了術(shù)中ICG造影和FLOW 800后續(xù)分析以及微血管多普勒超聲檢查。其中,FLOW 800與術(shù)后DSA結(jié)果符合率為80.1%(25 of 31),而微血管多普勒超聲與術(shù)后DSA結(jié)果符合率為77.4%(24 of 31)。統(tǒng)計學(xué)分析顯示,FLOW 800與術(shù)后DSA用于顱內(nèi)動脈瘤手術(shù)效果診斷評價相關(guān)性良好p=0.0033),且兩種方法無顯著差異p=0.2888,correlated X2=1.1250)。而對FLOW 800與術(shù)后DSA結(jié)果不符者的進一步分析,結(jié)果并未發(fā)現(xiàn)明確的差異預(yù)測因素。在對FLOW 800定量分析功能進行評價的結(jié)果中我們發(fā)現(xiàn),FLOW 800特異性血流測量結(jié)果與微血管多普勒超聲結(jié)果兩者無明顯相關(guān)性(P0.05)。第二部分,FLOW 800“彩色地圖”幫助有效辨認并完全切除AVM10例,結(jié)果被術(shù)后DSA證實。另一例患者因畸形血管團位置深在,術(shù)中無法通過ICG造影和FLOW 800發(fā)現(xiàn)而利用多模態(tài)導(dǎo)航實現(xiàn)病變完全切除。在FLOW800特異性血流分析結(jié)果中,病變鄰近腦皮層血流“通過時間”在AVM切除后明顯較術(shù)前縮短(p0.01),而病變遠隔皮層血流手術(shù)前后無顯著變化(p0.05)。其它血流參數(shù)如“最大熒光強度”和“腦血流指數(shù)”等,在各時期均未發(fā)現(xiàn)顯著改變。結(jié)論：總之,ICG熒光造影及FLOW 800技術(shù)在神經(jīng)血管手術(shù)中用于術(shù)中血流動態(tài)評估快速、有效。該技術(shù)可進一步提高手術(shù)安全性及術(shù)者信心。 “彩色地圖”功能可用于高分辨觀察血管結(jié)構(gòu)以及快速判斷血流動態(tài),并在AVM手術(shù)中效果尤為顯著。FLOW 800特異性血流分析可在一定程度上提供更多的血流灌注信息。然而,將其單獨用于腦血流測量,結(jié)果并不可靠。
[Abstract]:Objective: the purpose of this study was to report on the preliminary experience of indocyanine green videoangiography (ICG) fluorescein and FLOW 800 branches in neurovascular surgery in recent years, and to use the microvascular Doppler ultrasonography (1microvascular Doppler sonography, mDs) and cerebral blood in the operation of intracranial aneurysms. The results of digital subtraction angiography (DS A) were compared to evaluate the effectiveness of this new technique. In the stepwise resection of the arteriovenous malformation (AVM), we evaluated the effectiveness of its quantitative assessment of blood flow and cerebral perfusion. Method: in the first part, we will make FLOW 800 in the operation. All the findings were recorded with the microvascular Doppler ultrasound, and the results were compared with the postoperative DSA. For the FLOW 800 in the operation, we recorded separately and used for subsequent analysis. We evaluated the accuracy of the FLOW 800 by comparing the FLOW800 and postoperative DSA results. And FLOW 800 and postoperatively. We used to further predict the risk factors for this difference. In order to evaluate the FLOW800 quantitative analysis, we compared the results of the specific blood flow measurement with the results of the microvascular Doppler ultrasound and analyzed the two correlation. Second, we divided the blood supply artery before AVM resection. After three periods after AVM resection, ICG and FLOW 800 were performed respectively. We used the "color map" function to observe the vascular structure and quickly determine the blood flow dynamics. We used the FLOW 800 specific blood flow parameters, including "maximum strength", "delay time", "through time" and "cerebral blood flow index". The hemodynamic changes of AVM (blood supply artery, malformed vessel and drainage vein) and adjacent and distant brain tissues (arteries and cerebral cortex) were recorded and used for real-time measurement of local blood flow and cerebral perfusion. Results: Part 1, we performed 31 cases of intracranial aneurysms in 25 patients followed by intraoperative ICG and FLOW 800. Analysis and microvascular Doppler ultrasonography. Among them, the coincidence rate of FLOW 800 and postoperative DSA was 80.1% (25 of 31), while the coincidence rate of microvascular Doppler ultrasound and postoperative DSA was 77.4% (24 of 31). Statistical analysis showed that FLOW 800 and postoperative DSA used for intracranial aneurysm operation diagnostic evaluation were good p=0.0033), and two species were found. There was no significant difference in p=0.2888, correlated X2=1.1250). The further analysis of FLOW 800 and postoperative DSA results did not find a clear difference predictor. In the evaluation of the quantitative analysis of FLOW 800, we found that the specific blood flow measurement results of FLOW 800 and the results of microvascular Doppler ultrasound were two. There was no significant correlation (P0.05). The second part, FLOW 800 "color map" helped to identify and completely remove AVM10 cases. The result was confirmed by DSA after operation. The other patient was unable to use multimodal navigation through ICG contrast and FLOW 800 to realize complete resection of the lesions. In FLOW800 specific blood flow. In the analysis, the "passing time" of the adjacent cerebral cortex was significantly shorter after AVM resection than before the operation (P0.01), but there was no significant change before and after the operation (P0.05). Other blood flow parameters, such as "maximum fluorescence intensity" and "cerebral blood flow index", were not significantly changed at all times. Conclusion: in a word, ICG fluore The technique of radiography and FLOW 800 is fast and effective in the evaluation of blood flow in the operation of neurovascular surgery. This technique can further improve the safety of the operation and the confidence of the operator. "Color map" function can be used for high resolution observation of vascular structure and rapid determination of blood flow dynamics, and the effect of AVM operation is particularly significant for the specificity of.FLOW. Blood flow analysis can provide more blood perfusion information to some extent. However, it is not reliable to use it alone in cerebral blood flow measurement.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R651

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