术中超声辅助在显微手术切除幕上海绵状血管瘤中的应用  

Intraoperative ultrasound in microsurgical resection of supratentorial cavernous malformations

作　　者：毛进鹏[1] 李晓鹏 李刚 陶安宇 毛峰 欧一博 王宝峰 何跃 郭东生[2] Mao Jinpeng;Li Xiaopeng;Li Gang;Tao Anyu;Mao Feng;Ou Yibo;Wang Baofeng;He Yue;Guo Dongsheng(Department of Neurosurgery,Tianmen First People's Hospital of Hubei Province,Tianmen 431700,China;Department of Neurosurgery,Tongji Hospital,Tongji Medical School,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Ultrasound,Tongji Hospital,Tongji Medical School,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]湖北省天门市第一人民医院神经外科,431700 [2]华中科技大学同济医学院附属同济医院神经外科,武汉430030 [3]华中科技大学同济医学院附属同济医院超声科,武汉430030

出　　处：《中华神经医学杂志》2020年第2期170-175,共6页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金面上项目(81671154)。

摘　　要：目的探讨术中超声在辅助显微手术切除幕上海绵状血管瘤中的应用价值及技巧。方法收集华中科技大学同济医学院附属同济医院神经外科自2018年3月至2019年3月收治的31例幕上海绵状血管瘤患者资料,所有患者均应用术中超声辅助显示病灶位置、大小及病灶与周围组织结构的关系,据此选择合理的手术路径;同时借助术中超声实时监测切除程度。统计患者病灶切除情况及并发症发生情况。术后随访3~6个月,采用改良Rankin量表(mRS)评分评估患者预后。结果31例患者中,术前MRI诊断海绵状血管瘤35个,手术切除病灶33个,另2个为多发病变,位于术野对侧未予切除。术中应用超声实时监测结合止血纱定位技术均一次性找到病灶,定位准确性100%,视野内病灶全部切除。术后无感染,无死亡病例。随访期间,28例患者mRS评分0分;余3例术后神经功能损伤患者神经功能部分恢复。结论术中超声实时监测辅助显微切除幕上海绵状血管瘤安全有效。Objective To analyze the application value and clinical experience of intraoperative ultrasound in microsurgical resection of supratentorial cavernous malformations.Methods From March 2018 to March 2019,31 patients with supratentorial cavernous malformations were operated with assistance of intraoperative ultrasound in our hospital.Intraoperative ultrasound could clearly show the locations and sizes of the lesions,and relations of lesions with surrounding structures to choose appropriate surgical routes.The degrees of resection were judged and complications were recorded.The patients were followed up for 3-6 months,and modified Rankin scale(mRS)was used to evaluate the prognoses.Results In these 31 patients,35 cavernous hemangiomas were diagnosed by MR imaging before surgery;33 lesions were removed surgically,and the other two lesions located in the contralateral side of the operative field were not removed.The accuracy of intraoperative ultrasound guiding the lesions was up to 100%.There were no postoperative infections or deaths.During follow-up,mRS score of 28 patients was 0;the other 3 patients with postoperative neurological impairment recovered partially during follow-up.Conclusion With the help of real-time monitoring of intraoperative ultrasound and location technique of small pieces of hemostatic yarn,patients with supratentorial cavernous malformations could acquire satisfactory prognosis through meticulous microsurgery.

关 键 词：海绵状血管瘤 术中超声 显微外科手术 

分 类 号：R651[医药卫生—外科学]