微型探头血管多普勒超声在神经内镜经鼻鞍区肿瘤切除术中的应用价值  

Application value of intraoperative microvascular Doppler ultrasound in neuroendoscopic transnasal resection of sellar tumors

作　　者：颜燕红[1] 惠品晶[1] 陆紫微[2] 王润川 张白[1] 虞正权[3] 陈罡[3] 王中[3] Yan Yanhong;Hui Pinjing;Lu Ziwei;Wang Runchuan;Zhang Bai;Yu Zhengquan;Chen Gang;Wang Zhong(Carotid and Cerebrovascular Ultrasound,Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Radiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Neurosurgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院神经外科-颈脑血管超声,苏州215006 [2]苏州大学附属第一医院放射科,苏州215006 [3]苏州大学附属第一医院神经外科,苏州215006

出　　处：《中华神经外科杂志》2022年第2期117-122,共6页Chinese Journal of Neurosurgery

基　　金：苏州市民生科技项目(SS202061);苏州市科技示范工程项目(SS201859)。

摘　　要：目的探讨微型探头血管多普勒(MVD)超声在神经内镜经鼻鞍区肿瘤切除术中的应用价值。方法回顾性分析2017年9月至2021年4月苏州大学附属第一医院神经外科在肿瘤切除术中应用MVD超声的29例鞍区肿瘤患者的临床资料。其中,14例患者采用神经内镜经鼻肿瘤切除术(神经内镜组),另15例采用开颅肿瘤切除术(开颅组)。病灶切除后颈内动脉(ICA)走行清晰显露,术者据此判断MVD超声检测结果是否准确。术后48 h内复查头颅MRI、增强CT和头颈部CT血管成像(CTA),评估病灶的切除程度和颅内血管损伤情况。比较两组基线资料、术中应用MVD超声时血压(包括收缩压和舒张压)和获取的ICA血流动力学参数[包括:收缩期峰值流速(Vp)、舒张期末流速(Vd)、平均流速(Vm)、脉动指数(PI)、阻力指数(RI)]、术中应用MVD的检测次数、根据检测结果对肿瘤切除方向的调整率及手术结果。结果29例患者中,28例(96.6%)患者在术中被探及病灶周围存在ICA的血流频谱,且肿瘤切除后术者证实MVD超声引导的ICA走行均准确,准确率为100%(28/28)。术后复查头颅MRI显示,26例(89.7%)患者为肿瘤完全切除,3例(10.3%)为次全切除;复查CTA显示,所有患者的颅内血管均未损伤。所有患者在术后均未发生出血或缺血性卒中。术后病理学结果显示,脑膜瘤10例,垂体腺瘤12例,脊索瘤5例,畸胎瘤2例。两组的年龄、性别、高血压病史、糖尿病史、高脂血症、吸烟史、C-反应蛋白、体质量指数、临床表现、肿瘤最大径、形态、包绕和(或)推移ICA的情况及增强MRI表现的差异均无统计学意义(均P>0.05),基线基本一致,具有可比性。两组术中应用MVD超声的检测次数、根据检测结果对肿瘤切除方向的调整率、应用MVD超声检测时血压和获取的ICA血流动力学参数、肿瘤完全切除率及术后并发症发生率间的差异均无统计学意义(均P>0.05)。结论在神经内�Objective To investigate the application value of intraoperative microvascular Doppler(MVD)ultrasound in neuroendoscopic transnasal resection of sellar region tumors.Methods A retrospective analysis was conducted on the clinical data of 29 patients with sellar tumors who underwent neurosurgery with application of MVD at the Department of Neurosurgery,the First Affiliated Hospital of Soochow University from September 2017 to April 2021.Among them,14 patients underwent neuroendoscopic transnasal tumor resection(neuroendoscopic group)and 15 patients underwent craniotomy for tumor resection(craniotomy group).After lesion resection,the internal carotid arteries(ICA)were clearly exposed,and then the results detected by MVD ultrasound accurate or not were judged by the operators.To evaluate the degree of tumor resection and intracranial vascular injury,head MRI,cranial enhanced CT and CT angiography(CTA)of head and neck were performed within 48 h after operation.The baseline data and hemodynamic parameters of ICA detected by MVD were compared between the two groups,which included the peak systolic velocity(Vp),end diastolic velocity(Vd),mean velocity(Vm),pulsatility index(PI),resistance index(RI),blood pressures(including systolic and diastolic blood pressures),the times of MVD measurements,and the adjustment rate of resection direction according to the detection results during surgery.Results Among the 29 patients,the blood flow spectrum of ICA was detected in 28(96.6%),and the location of ICA guided by MVD was confirmed to be accurate after tumor resection,the accuracy is 100%(28/28).Postoperative CT showed that 26 patients(89.7%)had complete tumor resection,and 3 patients(10.3%)had subtotal resection.Reexamination of CTA indicated no damage to intracranial blood vessels in those patients.None of the cases experienced bleeding or ischemic stroke after surgery.Postoperative pathological results revealed meningioma in 10 cases,pituitary adenoma in 12 cases,chordoma in 5 cases and teratoma in 2 cases.There were no statis

关 键 词：脑肿瘤 自然腔道内镜手术 超声检查 多普勒 血管 鞍区 

分 类 号：R739.41[医药卫生—肿瘤]