基于球囊闭塞试验的脑血管侧支循环代偿能力评估及临床意义  

Clinical significance of cerebral collateral circulation assessment based on Balloon Test Occlusion

作　　者：孙增峰[1] 尚彦国[2] 盛志国 朱华雨[1] 佟小光[2] SUN Zeng-feng;SHANG Yan-guo;SHENG Zhi-guo;ZHU Hua-yu;TONG Xiao-guang(Grade 2018,Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University,Tianjin 300070,China;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases,Tianjin 300350,China)

机构地区：[1]天津医科大学神经内外科及神经康复临床学院,300070 [2]天津市环湖医院神经外科,天津市脑血管与神经变性重点实验室,300350

出　　处：《中国现代神经疾病杂志》2022年第5期341-347,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：天津市科技计划项目(项目编号:18ZXDBSY00180)。

摘　　要：目的通过颈内动脉球囊闭塞试验(BTO)评估Willis环前循环和后循环侧支开放情况和代偿能力,以及患者对颈内动脉闭塞耐受能力。方法纳入2016年6月至2021年9月在天津市环湖医院行颈内动脉BTO试验的85例(87侧)患者,BTO试验联合DSA观察前循环和后循环结构完整性、开放比例和代偿能力,对比分析不同组别BTO试验阳性率。结果本组有8侧占9.20%(8/87)BTO试验阳性,前交通动脉缺如、闭塞侧完全胚胎型大脑后动脉、闭塞侧前后循环均不开放患者阳性率分别高于前交通动脉未缺如[3/5对6.10%(5/82);Fisher确切概率法:P=0.005]、非完全胚胎型大脑后动脉[3/7对6.25%(5/80);Fisher确切概率法:P=0.015]、前循环开放[3/6对6.17%(5/81);Fisher确切概率法:P=0.009]和后循环开放[20%(5/25)对0(0/59);Fisher确切概率法:P=0.002]患者;仅前循环开放患者阳性率高于前后循环均开放患者[13.04%(3/23)对0(0/3);Fisher确切概率法:P=0.022],前后循环均不开放患者亦高于仅前循环开放患者[2/2对13.04%(3/23);Fisher确切概率法:P=0.033]和前后循环均开放患者[2/2对0(0/56);Fisher确切概率法:P=0.001]。颈内动脉闭塞后,闭塞侧大脑前动脉供血区经单一前循环代偿74侧占88.10%(74/84)、经单一后循环代偿3侧占3.57%(3/84)、经前后循环共同代偿5侧占5.95%(5/84)且均为有效代偿[美国介入和治疗性神经放射学学会/美国介入放射学学会(ASITN/SIR)分级3~4级],前后循环均未代偿2侧占2.38%(2/84,ASITN/SIR分级为零);闭塞侧大脑中动脉供血区经单一前循环代偿23侧占27.38%(23/84)且有效代偿为22.62%(19/84),经单一后循环代偿14侧占16.67%(14/84)、经前后循环共同代偿45侧占53.57%(45/84)且均为有效代偿,前后循环均未代偿2侧占2.38%(2/84,ASITN/SIR分级为零);4种代偿方式对大脑前动脉(χ^(2)=53.000,P=0.000)和大脑中动脉(χ^(2)=54.244,P=0.000)供血区的代偿能力差异有统计学意义,前后循环共同代偿能力高�Objective To analyze compensatory ability of the cerebral collateral circulation and relevant factors affecting cerebral ischemic tolerance for internal carotid artery(ICA)occlusion by Balloon Test Occlusion(BTO),providing reference basis for the selection of treatment methods in tumors or complicated aneurysms with ICA involved.Methods The clinical data of 87 cases BTO(85 patients,two of whom underwent bilateral BTO)of ICA in Tianjin Huanhu Hospital from June 2016 to September 2021 were analyzed retrospectively.The integrity of anterior or posterior of circulation structure,collateral compensatory capacity,tolerance to ICA occlusion and its influencing factors were analyzed.Results There were 8[9.20%(8/87)]BTO positive cases.The positive rate was of cases with incomplete anterior communicating artery was higher than those with complete anterior communicating artery[3/5 vs.6.10%(5/82);Fisher’s exact probability:P=0.005].The positive rate of cases with complete fetal posterior cerebral artery(fPCA)which was higher than those without complete fPCA[3/7 vs.6.25%(5/80);Fisher’s exact probability:P=0.015].The positive rate of cases with non-open anterior circulation which was higher than those cases with open anterior circulation[3/6 vs.6.17%(5/81);Fisher’s exact probability:P=0.009].The positive rate of cases with non-open posterior circulation which was higher than those cases with open posterior circulation[20%(5/25)vs.0(0/59);Fisher’s exact probability:P=0.002].Only the positive rate of patients with anterior circulation opening was higher than that of patients with open anterior circulation and open posterior circulation[13.04%(3/23)vs.0(0/3);Fisher’s exact probability:P=0.022],neither anterior nor posterior circulation opening were significantly higher than those with only anterior circulation opening[2/2 vs.13.04%(3/23);Fisher’s exact probability:P=0.033]and both anterior and posterior circulation opening[2/2 vs.0(0/56);Fisher’s exact probability:P=0.001].Once the ICA occluded,the anterior circulat

关 键 词：动脉闭塞性疾病 颈内动脉 气囊阻塞 大脑动脉环 侧支循环 

分 类 号：R651.12[医药卫生—外科学]