术中CT在脑血管疾病手术中的应用  

The application of intraoperative computed tomography in the surgery of cerebrovascular diseases

作　　者：孙正辉[1] 彭定伟[1] 武琛[1] 许百男[1] 薛哲[1] 王芙昱[1] 步啸[1] 董天翔[2] 

机构地区：[1]中国人民解放军总医院神经外科,北京100853 [2]中国人民解放军总医院放射科,北京100853

出　　处：《中华神经外科杂志》2013年第8期792-796,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨术中CT在脑血管疾病手术中的应用价值。方法收集2012年3月至8月收治的脑血管疾病患者38例。在手术前后行CT灌注成像（PCT）及CT血管造影（CTA）扫描，根据PCT及CTA情况，指导手术操作。结果术中扫描总时间19～21min。共行PCT77次、CTA36次，图像质量良好109次（96．46％），差4次。11例颈动脉狭窄，PCT提示rCBF、rCBV增加，rTTP缩短；CTA提示狭窄消失。25例动脉瘤共处理28个动脉瘤，1例脑灌注异常，调整动脉瘤夹位置后恢复。CT平扫均未见颅内出血。术后随访3—8个月，恢复良好37例（97．4％）、中残1例。结论术中CT是一种安全、操作简单、成像时间短、能提供高质量图像的技术。术中CT有助于及时发现动脉瘤及脑动静脉畸形残留、载瘤动脉及穿支动脉闭塞，是脑血管疾病外科手术中一种新型辅助技术。Objective To explore the clinical application of intraoperative computed tomography in the surgery of cerebrovascular diseases. Methods Thirty - eight patients with cerebrovascular diseases in our hospital from March to August 2012 were recruited. Combined CT perfusion （PCT） performed twice before and after surgery. Additionally CT angiography （CTA） was performed after surgery, surgical strategy would be changed. Results The total time for intraoperative PCT and CTA was 19 - 21 minutes. The quality of images, including 77 PCT parameter maps and 36 CTA images, were good in 109 cases （96.46%） ,and were poor in 4 cases. Of the 11 cases with carotid stenosis, PCT showed the rCBF and rCBV increased and rTI＇P decreased after CEA comparison with those before CEA. CTA showed the stenosis improved obviously. Of 25 cases with intracranial aneurysm, 28 aneurysms were treated successfully. Brain perfusion decreased in only 1 case, and improved after repositioning of the clip. The intraoperative routine CT scan revealed no cerebral hemorrhage. During followed - up period （3 - 8 months） the outcome was good in 37 cases （97.4%） and poor in 1 case. Conclusions Intraoperative CT with advantage of safety, simplicity, short acquisition time and providing high quality image, which was helpful to identify unexpected residual aneurysm and AVM, parental artery and perforating arteries occlusion in the surgery of cerebrovascular diseases, was a new and adjuvant technology in the surgery of cerebrovascular diseases.

关 键 词：脑血管障碍 外科手术 术中CT 

分 类 号：R651.1[医药卫生—外科学]