头颅CTA检查在微血管减压术前安全性评估中的临床意义  

Clinical significance of cranial CTA in safety assessment before microvascular decompression

作　　者：种玉龙 徐武[1] 王晶[1] 姜成荣 梁维邦[1] Chong Yulong;Xu Wu;Wang Jing;Jiang Chengrong;Liang Weibang(Department of Neurosurgery,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京210008

出　　处：《中华脑科疾病与康复杂志（电子版）》2021年第5期282-284,共3页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的探讨头颅CT血管造影(CTA)检查在微血管减压术(MVD)前安全性评价中的指导意义。方法回顾性分析南京鼓楼医院神经外科自2018年1月至2019年6月收治的明确诊断为原发性面肌痉挛及三叉神经痛患者的临床资料。所有患者术前均采用头颅CTA检查,以高龄(≥60岁)或合并基础疾病(如高血压、高血脂、糖尿病)患者为A组,余患者为B组,分析2组术前颅内动脉瘤检出率。按照治疗方式将A组分为2个亚组,其中检出颅内动脉瘤接受血管内治疗后再行MVD的患者为观察组,余首次行MVD的患者为对照组,观察2组患者的疗效及并发症发生情况。结果A组患者347例,其中动脉瘤23例,检出率6.63%;B组患者191例,其中动脉瘤3例,检出率1.57%,A组动脉瘤的检出率明显高于B组,差异具有统计学意义(P<0.05)。观察组术后治愈率和好转率分别为89.47%、10.53%,对照组治愈率和好转率分别为93.43%、5.11%,疗效相近,差异无统计学意义(P>0.05)。观察组与对照组术后并发症发生率分别为10.53%、9.48%,差异无统计学意义(P>0.05)。结论MVD术前头颅CTA检查能够有效地发现潜在血管隐患,尤其对高龄或合并基础疾病的患者,排除手术禁忌,指导手术治疗,对MVD手术安全性评价具有重要指导意义,且动脉瘤患者血管病变治疗干预后再行MVD手术的疗效及安全性仍是可靠的。Objective To explore the guiding significance of cranial CT angiography(CTA)in preoperative safety assessment of microvascular decompression(MVD)patients.Methods The clinical data of patients with primary hemifacial spasm and trigeminal neuralgia treated in the Neurosurgery Department of Nanjing Drum Tower Hospital from January 2018 to June 2019 were analyzed retrospectively.All patients were examined by head CTA before operation.Patients aged over 60 years old or with underlying diseases(such as hypertension,hyperlipidemia,diabetes)were A group.The remaining patients were B group.The detection rate of intracranial aneurysms in group A and B was analyzed.Group A was divided into two subgroups according to the treatment method.The patients with intracranial aneurysms who underwent MVD after intravascular treatment were the observation group,and the other patients who underwent MVD for the first time were the control group.The curative effects and complications of the two groups were observed.Results In group A,there were 347 cases,of which 23 cases(6.63%)were found aneurysms.In group B,aneurysms were detected in 3(1.57%)of 191 cases,and the detection rate of aneurysms in group A was significantly higher than that in group B(P<0.05).The postoperative cure rate and recovery rate of the observation group were 89.47%and 10.53%,respectively.The cure rate and recovery rate of the control group were 93.43%and 5.11%.The total incidence of postoperative complications in the observation group and the control group was 10.53%and 9.48%,without significant difference(P>0.05).Conclusion Cranial CTA examination before MVD can effectively detect potential vascular hazards in MVD patients.Especially for elderly patients or patients with underlying diseases,exclusion of surgical contraindications and guidance for surgical treatment are of great guiding significance for the safety evaluation of MVD surgery.Moreover,the efficacy and safety of MVD surgery after intervention for vascular lesions of aneurysms are still reliable.

关 键 词：微血管减压术 头颅CT血管成像 面肌痉挛 三叉神经痛 术前评估 

分 类 号：R651.1[医药卫生—外科学]