颈动脉分歧部切除术后脑血流代偿机制的血流动力学及影像学研究  

A Hemodynamic and Imaging Study on Compensatory Collateral Cerebral Blood Crossflow after Resection of Carotid Bifurcation

作　　者：高明[1,2] 李树玲[1,2] 刘经祖 颜宪秋[1,2] 葛正津 孙永达[1,2] 

机构地区：[1]天津市肿瘤医院头颈科 [2]天津大学应用物理系

出　　处：《中国肿瘤临床》1998年第8期553-557,共5页Chinese Journal of Clinical Oncology

摘　　要：天津市肿瘤医院自１９７９年首次成功地完成了第１例计划性不进行血管重建的肿瘤合并颈动脉分歧部切除术以来，到１９９３年共行此术２０例。术后，除因其它原因死亡４例外，１６例健在，始终未出现脑血管合并症。为了解颈动脉分歧部切除术后脑血流代偿供血机制，对术后健在的９例（第１组）及术前颈动脉压迫锻炼合格的６例（第２组）患者进行了彩色多普勒血流显像、经颅多普勒、氙脑图成像仪、颈脑血管数字减影造影、单光子计算机断层扫描及微机脑血流图等现代有关脑血流动力学及影像学的检测研究。多项检测研究结果显示：１）两组患者脑代偿供血均良好，表明切除一侧颈动脉后仍能充分代偿脑正常供血；２）脑血流代偿供血的主要方式是通过增加血流速度、增粗血管内径及开放脑底动脉环的交通支来完成；３）术前颈动脉压迫锻炼确实能起到促进脑侧支循环充分建立的作用，压迫锻炼须与脑血流图监测相结合。Since the first case of planned resection of carotid bifurcation without vascular reconstruction was succeeded in 1979, a total of 20 cases underwent this operation up to 1993. Of these 20 cases, 3 died of the original malignancy and 1 succumbed to glottic obstruction, 16 cases survived well for 2 14 years with intact cerebral blood supply. In order to find out the compensatory mechanism of collateral cerebral blood crossflow after carotid artery resection,a series of hemodynamic and imaging examinations including color Doppler flow imaging ,transcranial Doppler,Xe133 encephalography,single emission computerized tomography, digital substration angiography and computerized rheoencephalography were employed on 9 survived cases (group 1) as well as 6 cases who have undergone carotid compressing exercise (group 2).The results can be summarized as:1) The compensatory bilateral cerebral blood supply was sufficient in all of the two groups, testified by the fact that the patients lived well with unilateral carotid artery blood supply; 2) Increase of vascular internal diameter and the blood stream speed ,and opening of communicating branches of Willis circle are the principal ways of compensation; 3) The CREG guided preoperative cerebral compressing exercise could effectively promote the improvement of the collateral cerebral crossflow.

关 键 词：颈动脉分歧部 切除术 颈部肿瘤 血流动力学 

分 类 号：R739.910.5[医药卫生—肿瘤]