吲哚菁绿荧光血管造影在颅内前循环动脉瘤夹闭术中的应用  

Intraoperative indocyanine green angiography in microsurgical clipping for patients with intracranial anterior circulation aneurysms

作　　者：张国锋[1] 唐尤佳 高翔[1] 淦作松[1] 梁锐[1] 熊振坤[1] 郑立群[1] 吴维蒲 

机构地区：[1]九江市第一人民医院神经外科,332000

出　　处：《中华神经医学杂志》2016年第9期923-927,共5页Chinese Journal of Neuromedicine

基　　金：江西省卫生计生委科技计划项目（20157068）

摘　　要：目的探讨吲哚菁绿（ICG）荧光血管造影在颅内动脉瘤显微夹闭术中的应用价值。方法回顾性分析九江市第一人民医院神经外科自2014年1月至2015年10月应用ICG荧光血管造影技术指导动脉瘤夹闭手术治疗的77例（83个动脉瘤）前循环动脉瘤患者临床资料。所有患者术中均行ICG荧光血管造影检查，根据造影结果及时调整动脉瘤夹。术后行CTA或DSA判断动脉瘤夹闭效果：术后3个月采用GOS评分评估患者预后。结果77例患者共行ICG荧光血管造影163次。发现动脉瘤颈残留3例，载瘤动脉狭窄2例，远端分支狭窄2例，后交通动脉误夹2例，穿通支闭塞l例．均根据造影结果及时调整动脉瘤夹。术后1周出现迟发性缺血性梗死1例，术后2周复查DSA或CTA显示动脉瘤均夹闭完全，无残余瘤体。术后3个月患者GOS评分为（4．5±1．1）分。结论术中ICG荧光血管造影对判断前循环动脉瘤夹闭后瘤颈、载瘤动脉狭窄情况，以及显示动脉瘤远端血管和穿支血管的状况有重要的参考价值．并且安全可靠。Objective To study the application of intraoperative indocyanine green （ICG） fluorescein angiography in intracranial aneurysm clipping, and analyze the aneurysm clip closing degrees, postoperative complications, and its efficacy and safety. Methods A total of 77 patients with 83 intracranial anterior circulation aneurysms, admitted to our hospital from January 2014 to October 2015, were chosen in our study; these patients were treated by microsurgical clipping; aneurysm clip results were adjusted according to the results of intraoperative ICG fluorescein angiography. Postoperative CT, CTA, and DSA were used to evaluate the efficacy of aneurysm clipping. Glasgow outcome scale （GOS） was employed to evaluate the prognosis of the patients 3 months aider surgery. Results There were 163 times of ICG fluorescein angiography performed in these 77 patients with excellent image quality and resolution. Intraoperative fluorescein angiography found residual aneurysm neck in 3 patients, parent artery stenosis in 2, distal branches stenosis in 2, clipping of posterior communicating artery in 2, and perforating branch occlusion in one. These clips were adjusted according to the coronary angiography results. Ischemic infarction was found in one patient 7 days later. All aneurysms were clipped completely by detection of CTA or DSA within postoperative 2 weeks. The GOS scores were 4.5±1.1 at 3 months after surgery. Conclusion Intraoperative ICG fluorescence angiography may present real time assessment of the residual neck ofaneurysms, stenosis or occlusion of the parent artery, distal vessel of aneurysms and perforating arteries; therefore, this angiography may contribute to reduce the postoperative complications, enhance operative safety and improve the outcome of patients after intracranial aneurysm surgery.

关 键 词：颅内动脉瘤 前循环 显微夹闭术 吲哚菁绿 荧光造影 

分 类 号：R651.12[医药卫生—外科学]