实时超声检测在脑海绵状血管瘤切除术中的应用研究  

Application of intraoperative real-time ultrasound in resection of cerebral cavernous hemangioma

作　　者：楼林[1] 张健[1] 赵元元[1] 陈书达[1] 

机构地区：[1]浙江省人民医院神经外科,杭州310014

出　　处：《浙江医学》2013年第4期283-285,288,共4页Zhejiang Medical Journal

摘　　要：目的探讨术中实时超声检测在脑海绵状血管瘤手术中的应用价值。方法将39例脑海绵状血管瘤患者按术中是否采用实时超声检测引导手术分为两组。超声引导组20例，术中通过超声检测显示海绵状血管瘤的位置、大小、形态、深度及其与周围组织和血管的关系，制定最佳手术入路，并通过实时扫描，监测病灶的切除情况，病灶切除后再次超声探查有无残留病灶和血肿。另19例为对照组，术中不用超声引导，其他均按传统方法手术。比较两组患者病灶切除时间、脑组织切开次数、切13肿瘤直径比值以及患者症状改善及并发症发生情况。结果（1）两组患者均无手术死亡，病灶均在手术显微镜下全切除。影像学与病理检查诊断符合率达100％。（2）两组患者病灶在手术显微镜下均被发现，超声引导组患者术中病灶显示率为100％，并完整显示病灶的大小、位置、范围及形态，准确定位。（3）脑组织切开次数超声引导组均在3次以下，而对照组仅10例（52．63％）在3次以下，7例（36．84％）达3次以上；切口肿瘤直径比值超声引导组为1．22±0．22，低于对照组的1．45±0，36；病灶平均切除时间超声引导组为（55．70±12．66）min，少于对照组的（82．16±31．23）min；并发症发生率超声引导组为5．00％，明显低于对照组的15．79％；两组上述数据的差异均有统计学意义（均P〈O．05）。结论术中实时超声引导对脑海绵状血管瘤病灶的定位准确、可靠。能指导术者准确选择手术入路，避开重要的脑功能区、血管和其他重要结构，精准切除病灶，缩短手术时间，减少神经组织损伤和降低手术并发症发生率。Objective To investigate the clinicat value of intraoperative rear-time ultrasound in resection of cerebral cavernous hemangioma. Methods Thirty nine patients with cerebral cavernous hemangioma were randomly assigned to receive ul- trasound-guided resection （ultrasound group, n=20） or conventional resection （control group, n= 19） of hemangioma. The operat- ing time, number of brain tissue incision, ratio of diameter of incision to tumor, postoperative complications and improvement of symptom were analyzed three weeks after operation. Results The focuses were all successfully resected and there was no fatal case in both groups. The coincidence rate of MRI with pathology was 100%. The intraoperative ultrasound exactly indicated the position, size, modality and depth of cavernous hemangioma. All focuses were found via operating microscope. The operating time of ultrasonic group was significant shorter than that of control group. Numbers of brain tissue incision and ratio of diameter of incision to tumor in urasonic group were significant less than those in control group. The incidence of postoperative complica- tions in ultrasonic group was significantly lower than that in control group. Conclusion The intraoperative real-time ultrasound can shorten operative time, minimize cerebral damage and reduce postoperative complications in resection of cerebral cavernous hemangioma.

关 键 词：术中超声 定位 海绵状血管瘤 

分 类 号：R739.41[医药卫生—肿瘤]