本文選題：腦血管障礙 + 外科手術(shù)��； 參考：《中國人民解放軍醫(yī)學(xué)院》2013年碩士論文

【摘要】：目的：評價頸動脈內(nèi)膜切除術(shù)（CEA）中CT灌注成像（PCT）灌注參數(shù)的變化，分析大腦中動脈及大腦前動脈供血區(qū)的腦血流動力學(xué)變化，探討術(shù)中CT在CEA和顱內(nèi)動脈瘤手術(shù)中的應(yīng)用價值。 方法：收集2012年3月至2013年3月解放軍總醫(yī)院神經(jīng)外科收治的腦血管疾病44例，其中頸動脈狹窄16例、顱內(nèi)動脈瘤28例。所有病例均在術(shù)中CT手術(shù)室完成手術(shù)，在術(shù)前及術(shù)中分別行PCT及CTA掃描。在CEA術(shù)中，選取大腦中動脈供血區(qū)及大腦前動脈供血區(qū)作為感興趣區(qū)，獲得腦血流量（CBF）、腦血容量（CBV）及達峰時間（TTP）偽彩圖及定量數(shù)據(jù)，計算術(shù)側(cè)與對側(cè)的相對值rCBF、rCBV及rTTP。分別比較術(shù)側(cè)和對側(cè)各灌注參數(shù)、術(shù)前和術(shù)中各相對灌注參數(shù)。在顱內(nèi)動脈瘤手術(shù)中，根據(jù)動脈瘤所在部位選取感興趣區(qū)，獲得CBF、CBV及TTP偽彩圖及各灌注參數(shù)。根據(jù)兩次PCT及CTA情況，指導(dǎo)手術(shù)操作。 結(jié)果：1、CEA術(shù)中：（1）大腦前動脈供血區(qū)：各參數(shù)比較差異無統(tǒng)計學(xué)意義（P＞0.05）。（2）大腦中動脈供血區(qū)：CEA術(shù)前，術(shù)側(cè)與對側(cè)CBF及CBV比較差異無統(tǒng)計學(xué)意義（P＞0.05），TTP延長（P＜0.05）；CEA術(shù)中，，術(shù)側(cè)與對側(cè)比較，CBF及CBV明顯增加（P＜0.05），TTP明顯縮短（P＜0.05）。CEA術(shù)前及術(shù)中，rCBF及rCBV增加，rTTP縮短，差異有統(tǒng)計學(xué)意義（P＜0.05）。（3）術(shù)中PCT未見腦過度灌注。（4）術(shù)中CTA顯示病變部位狹窄程度明顯改善。（5）16例CEA預(yù)后良好。2、顱內(nèi)動脈瘤手術(shù)中：（1）25例術(shù)中PCT未見腦灌注明顯變化；1例后交通動脈瘤夾閉術(shù)中，術(shù)中PCT發(fā)現(xiàn)術(shù)側(cè)腦灌注明顯變差，調(diào)整動脈瘤夾后，再次行PCT提示術(shù)側(cè)腦灌注明顯好轉(zhuǎn)。（2）術(shù)中CTA提示無動脈瘤殘頸、載瘤動脈狹窄或閉塞。（3）手術(shù)共處理31個動脈瘤，恢復(fù)良好27例（96.43%）、中殘1例（3.57%）。3、共行PCT89次，CTA42次，圖像質(zhì)量良好127次（96.95%），差4次（3.05%）。4、術(shù)中PCT及CTA掃描平均耗時（19.87±0.64）min。5、術(shù)中CT平掃均未見顱內(nèi)出血，其中2例蛛網(wǎng)膜下腔出血伴血腫者，術(shù)中CT平掃顯示血腫清除滿意。 結(jié)論：1、術(shù)中CT是一種安全、操作簡單、成像時間短、能提供高質(zhì)量圖像的技術(shù)，能及時、準(zhǔn)確提供腦組織灌注及顱內(nèi)外血管解剖情況。2、rCBF、rCBV及rTTP是反映CEA術(shù)后早期腦血流動力學(xué)變化的敏感指標(biāo)。3、CEA術(shù)中MCA供血區(qū)腦血流動力學(xué)變化更明顯。4、術(shù)中CT有助于在顱內(nèi)動脈瘤手術(shù)中及時發(fā)現(xiàn)動脈瘤殘留、載瘤動脈及穿支動脈閉塞，可以作為腦血管疾病手術(shù)中一種新型輔助評估方法，尤其在顱內(nèi)復(fù)雜動脈瘤及顱內(nèi)血管重建術(shù)中作用更明顯。
[Abstract]:Objective: to evaluate the changes of perfusion parameters of CT perfusion imaging (PCT) in carotid endarterectomy (CEA), to analyze the cerebral hemodynamic changes in the middle cerebral artery and anterior cerebral artery, and to evaluate the value of CT in the operation of CEA and intracranial aneurysms. Methods: from March 2012 to March 2013, 44 cases of cerebrovascular diseases in neurosurgery department of PLA General Hospital were collected, including 16 cases of carotid stenosis and 28 cases of intracranial aneurysms. All cases were operated in CT operating room, and PCT and CTA were performed before and during operation respectively. During CEA operation, the middle cerebral artery (MCA) and the anterior cerebral artery (ACA) were selected as the regions of interest, and the pseudochromograms and quantitative data of CBFV, CBV and TTPwere obtained, and the relative values of rCBFV rCBV and rTTPwere calculated between the operative side and the contralateral side. The perfusion parameters of operative side and contralateral side, preoperative and intraoperative perfusion parameters were compared respectively. In intracranial aneurysm surgery, CBF CBV and TTP pseudochromatic images and perfusion parameters were obtained according to the location of the aneurysm. According to twice PCT and CTA, guide the operation. Results there was no significant difference in the blood supply area of anterior cerebral artery (P > 0.05) (P > 0.05). There was no significant difference in CBF and CBV between the operative side and the contralateral side (P > 0.05), and there was no significant difference between the operative side and the contralateral side (P > 0.05) in the extension of TTP during the operation (P < 0.05), and there was no significant difference between the operative side and the contralateral side (P > 0.05). Compared with the contralateral side, CBF and CBV increased significantly (P < 0.05) and TTP shortened significantly (P < 0.05). CEA increased rCBF and rCBV shortening before and during operation. The difference was statistically significant (P < 0.05) there was no cerebral hyperperfusion during PCT. (4) CTA showed significant improvement in stenosis degree of lesions in 16 cases. CEA prognosis was good in 16 cases. In 25 cases of intracranial aneurysm, no significant changes of cerebral perfusion were observed in 25 cases. In 1 case of posterior communicating aneurysm clipping, the intraoperative PCT found that the cerebral perfusion of the operative side became worse obviously. After adjusting the aneurysm clip, another PCT was performed to indicate that the lateral cerebral perfusion was obviously improved. 2) CTA showed that there was no aneurysm residual neck during the operation. 31 aneurysms were treated with aneurysm stenosis or occlusion. Among them, 27 cases recovered well, 1 case had middle disability (3.57%) and 42 times PCT 89 times (CTA42 times). The average time of PCT and CTA scan during operation was 19.87 鹵0.64 min. 5. There was no intracranial hemorrhage on plain CT scan. In 2 cases of subarachnoid hemorrhage with hematoma, CT plain scan showed satisfactory hematoma clearance. Conclusion: 1, CT is a safe, easy to operate, short imaging time, can provide high quality image technology, can be timely, Providing accurate cerebral tissue perfusion and anatomy of intracranial and extracranial vessels .2rCBFFrCBV and rTTP are sensitive indexes to reflect the early changes of cerebral hemodynamics after CEA .3The changes of cerebral hemodynamics in MCA feeding area during CEA operation are more obvious. Ct during operation is helpful in cranium. The residual aneurysm was found in time during the internal aneurysm operation. The occlusion of aneurysm carrying artery and perforating artery can be used as a new assistant evaluation method in cerebrovascular disease surgery, especially in complex intracranial aneurysm and intracranial vascular reconstruction.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R651.12;R816.1

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相關(guān)期刊論文 前2條

1 趙繼宗,王碩,王永剛,趙元立,于書卿,王嶸,王德江,張東,李勇;神經(jīng)內(nèi)鏡在顱內(nèi)動脈瘤的外科手術(shù)中的應(yīng)用[J];中華醫(yī)學(xué)雜志;2004年10期

2 趙繼宗;王碩;袁葛;許駿;金e

本文編號：2026494