术中荧光造影在前循环动脉瘤夹闭手术中应用的有效性研究  

The validity of indocyanine green angiography for the assessment of clipping of anterior circulation aneurysms.

作　　者：郭少雷[1] 梁丰[1] 江楠[2] 李雪松[3] 黄正松[1] 齐铁伟[1] 何科君[1] 罗莉娟[1] 洪奕珊[1] 

机构地区：[1]中山大学附属第一医院神经外科,广州510080 [2]中山大学附属第一医院麻醉科 [3]惠州市中心人民医院神经外科

出　　处：《中国神经精神疾病杂志》2014年第2期75-78,共4页Chinese Journal of Nervous and Mental Diseases

基　　金：广东省医学科研基金(编号:B2010079);广东省科技计划项目(编号:2009B030801130)

摘　　要：目的探讨术中荧光造影在颅内前循环动脉瘤显微手术治疗中的应用价值。方法前瞻性观察45例手术治疗的颅内前循环动脉瘤患者，术前采用CT脑动脉三维重建确诊；术中应用Pentero手术显微镜进行吲哚菁绿荧光造影（indocyaninegreenangiography，ICGA），术后常规数字减影脑血管造影（digitalsubtractionangiography，DSA），对比观察术中影像与术后影像检查结果符合情况；随访6—12月应用改良Rankin评分（modifiedRankinScale，mRS）评价预后。结果术中ICGA可清楚显示动脉瘤与载瘤血管及周围穿支动脉的关系，其观察结果与术后DSA显示的动脉瘤颈残余、载瘤动脉狭窄、穿支动脉闭塞的情况基本符合；本组无死亡，手术相关并发症4．4％，治疗优良率91．1％（mRS〈3）。结论术中ICGA为颅内前循环动脉瘤的显微手术提供丰富的血管结构和血流信息，有助于动脉瘤的安全夹闭以及穿支血管完整保留。Objective Indocyanine green angiography （ICGA） is a promising technique for assessment of clipping for intracranial aneurysms. The present study was to examine Intra-operative ICGA may help for clipping of anterior cir- culation aneurysms. Methods Forty-five patients with anterior circulation aneurysms undergoing clipping were included. Pre-operative CTA was obtained to analyze the location, direction, size and shape of the aneurysms. Intra-operative ICGA was performed on Pentero microscope. Routine digital subtraction angiography （DSA） were obtained. Coincidence of ICGA and DSA was analyzed. Clinical outcome was evaluated using modified Rankin scale in 6 to 12 months after surgery. Re- sults Aneurysm＇s parent artery and perforating branches were illustrated clearly on ICGA. Coincidence of ICGA and DSA for aneurysm remnant, patent artery narrowing and perforating branch occlusion were 97.8%, 93.3% and 91.1%, respec- tively. Conclusion Intra-operative ICGA is a quick, reliable and cost-effective assessment method of anterior circula- tion clipping, which may be useful during routine aneurysm surgery as an independent assessment or as an adjunct to intra- operative or postoperative DSA.

关 键 词：颅内动脉瘤 显微手术 吲哚菁绿荧光造影 

分 类 号：R651.1[医药卫生—外科学]