经颅脑血管多普勒超声在小儿Ⅰ型Chiari畸形诊断及疗效评估中的应用研究  

Application value of transcraniocerebral vascular Doppler ultrasonography in the diagnoses and postoperative evaluations of Chiari type Ⅰ malformation in children

作　　者：王君璐 张立 刘剑钢 刘瑜 肖波[1] Wang Junlu;Zhang Li;Liu Jiangang;Liu Yu;Xiao Bo(Department of Neurosurgery,Affiliated Children's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200062,China)

机构地区：[1]上海交通大学医学院附属儿童医院神经外科,上海200062

出　　处：《临床小儿外科杂志》2024年第2期140-146,共7页Journal of Clinical Pediatric Surgery

基　　金：上海市科学技术委员会上海市2020年度科技创新行动计划医学创新研究专项项目(20Y11905800)

摘　　要：目的研究经颅脑血管多普勒(transcraniocerebral vessel Doppler,TVD)超声技术在I型Chiari畸形患儿诊断以及术后疗效评估中的应用价值。方法回顾性分析2018年3月至2021年12月上海交通大学医学院附属儿童医院神经外科收治的27例Ⅰ型Chiari畸形患儿临床资料。按年龄分为两组,学龄前组(1~6岁)15例,学龄后组(7~16岁)12例。两组患儿均于术前、术后24 h及术后1个月行TVD超声探测,以后颅窝内双侧大脑后动脉(posterior cerebral artery,PCA)、椎动脉(vertebral artery,VA)及基底动脉(basilar artery,BA)为靶血管,收集相应靶血管的收缩期峰流速(peak systolic velocity,PSV)、舒张末期流速(end-diastolic velocity,EVD)及搏动指数(pulsative index,PI)等监测指标。分别比较两组患儿手术前后后颅窝动脉血流动力学差异;比较27例患儿术前TVD与MRI诊断结果的一致性,以及术后TVD检查结果与Tator疗效评估结果的一致性。结果学龄前组患儿手术后双侧PCA的PSV较术前增加[左侧:(44.25±13.06)cm/s比(66.76±14.45)cm/s,t=5.148,P=0.023;右侧:(45.12±13.41)cm/s比(65.33±10.12)cm/s,t=5.389,P=0.021]、PI较术前降低[左侧:(1.18±0.42)比(0.91±0.18),t=4.545,P=0.033;右侧:(1.24±0.48)比(0.92±0.13),t=4.776,P=0.028];双侧VA的PSV[左侧:(43.50±11.99)cm/s比(70.94±7.56)cm/s,t=7.042,P=0.008;右侧:(44.56±8.45)cm/s比(68.82±9.02)cm/s,t=6.833,P=0.009]、EVD[左侧:(19.01±9.22)cm/s比(27.18±8.53)cm/s,t=4.587,P=0.032;右侧:(18.28±5.77)cm/s比(28.32±7.26)cm/s,t=4.683,P=0.030]较术前增加,双侧PI较术前降低[左侧:(1.12±0.45)比(0.86±0.19),t=4.712,P=0.029;右侧:(1.31±0.46)比(0.84±0.31)cm/s,t=5.277,P=0.022];BA的PSV[(48.75±16.57)cm/s比(69.17±11.86)cm/s,t=5.413,P=0.019]、EVD[(27.73±7.34)cm/s比(27.18±8.53)cm/s,t=4.738,P=0.027]较术前增加、PI较术前降低[(1.13±0.55)比(0.90±0.28),t=4.721,P=0.030]。学龄后组患儿手术后双侧VA的PSV较术前增加[左侧:(48.16±18.47)cm/s比(53.77±24.73)cm/s,t=4.187,P=0.045;右�Objective To explore the application value of transcranialcerebral vessel Doppler(TVD)ultrasonography in the diagnoses and postoperative evaluations of typeⅠChiari malformation in children.Methods From March 2018 to December 2021,the relevant clinical data were retrospectively reviewed for 27 children with typeⅠChiari malformation.Based upon age,they were assigned into two groups of preschool(aged 1-6 year,n=15)and school-age(aged 7-16 year,n=12).TVD was detected at pre-operation,24 h post-operation and 1 month post-operation.Posterior cerebral artery(PCA),bilateral vertebral artery(VA)and basilar artery(BA)in posterior cranial fossa were selected as target vessels.Peak systolic velocity(PSV),end-diastolic velocity(EVD)and pulsative index(PI)of the corresponding target vessels were monitored.Hemodynamic profiles of posterior cranial fossa were compared in different age groups at pre-operation versus post-operation.The accuracy of diagnosis was compared with magnetic resonance imaging(MRI)at pre-operation and the consistency of efficacy compared with Tator evaluation post-operation.Results PSV of bilateral PCA post-operation spiked in preschool group as compared with that pre-operation[left(44.25±13.06)vs.(66.76±14.45)cm/s,t=5.148,P=0.023;right(45.12±13.41)cm/s vs.(65.33±10.12)cm/s,t=5.389,P=0.021]and PI declined[left(1.18±0.42)vs.(0.91±0.18),t=4.545,P=0.033;right(1.24±0.48)vs.(0.92±0.13),t=4.776,P=0.028],bilateral VA PSV[left(43.50±11.99)vs.(70.94±7.56)cm/s,t=7.042,P=0.008;right(44.56±8.45)vs.(68.82±9.02)cm/s,t=6.833,P=0.009],preoperative EVD rose[left(19.01±9.22)vs.(27.18±8.53)cm/s,t=4.587,P=0.032;right(18.28±5.77)vs.(28.32±7.26)cm/s,t=4.683,P=0.030]and preoperative bilateral PI dropped[left(1.12±0.45)vs.(0.86±0.19),t=4.712,P=0.029;right(1.31±0.46)vs.(0.84±0.31)cm/s,t=5.277,P=0.022],BA PSV[(48.75±16.57)vs.(69.17±11.86)cm/s,t=5.413,P=0.019],preoperative EVD increased[(27.73±7.34)vs.(27.18±8.53)cm/s,t=4.738,P=0.027]and preoperative PI decreased[(1.13±0.55)vs.(0.90±0.28),t=4.721,P=0.03

关 键 词：CHIARI畸形 超声检查 多普勒 经颅 颅窝 后 脑血管循环 外科手术 治疗结果 儿童 

分 类 号：R726.5[医药卫生—儿科]