颞浅动脉-大脑中动脉搭桥术近期效果的超声血流动力学评估  

Hemodynamic evaluation of the efficacy for superficial temporal artery-middle cerebral artery bypass with vascular ultrasonography

作　　者：罗雨萌 刘玉梅[1] 谌燕飞[2] 邢英琦[1] Luo Yumeng;Liu Yumei;Chen Yanfei;Xing Yingqi(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing Diagnostic Center of Vascular Ultrasound,Beijing Institute of Brain Disorders,Beijing 100053,China;Department of Interventional Neuroradiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管超声诊断科、北京市血管超声诊断中心、北京脑重大疾病研究院血管超声研究所,北京100053 [2]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华超声影像学杂志》2023年第3期250-256,共7页Chinese Journal of Ultrasonography

摘　　要：目的应用血管超声对颞浅动脉(STA)-大脑中动脉(MCA)搭桥术术后进行血流动力学分析,评估STA-MCA搭桥术的通畅性及近期效果。方法回顾性连续纳入2017年1月至2020年6月因MCA、颈内动脉(ICA)重度狭窄或闭塞,或烟雾病就诊于首都医科大学宣武医院神经外科行STA-MCA搭桥术,术前血管病变经超声检查诊断并经数字减影血管造影(DSA)证实,且术前行颅脑MRI检查及CT灌注检查的患者38例共41个手术半球为手术组。对照组纳入颈动脉及颅内动脉超声均未见明显异常的20位健康人40个半球。比较对照组及手术组术后1周、术后6个月、术后12个月患侧STA的收缩期峰值流速(PSV)、舒张末期流速(EDV)、平均流速(MV)、血管搏动指数(PI)、血管阻力指数(RI)、频谱形态及流量,双侧颈外动脉(ECA)、双侧MCA的PSV、EDV、PI、RI及频谱形态,患侧MCA远段血流方向、PSV、EDV、PI、RI及频谱形态等血流动力学参数。结果①STA-MCA搭桥术后1周、术后6个月、术后12个月时,STA内径、PSV、MV及流量分别较对照组显著升高(均P<0.05)。手术组3个复查时间点STA流量逐步减低(均P<0.05);STA内径、PSV、MV有下降趋势,但差异无统计学意义(均P>0.05)。②STA-MCA搭桥术后1周、术后6个月、术后12个月的STA/ECA PI及RI比值较对照组明显减低(0.61±0.15、0.61±0.16、0.65±0.12比0.96±0.13,均P<0.01;0.76±0.11、0.75±0.12、0.79±0.09比0.96±0.17,均P<0.01)。结论血管超声检查可以作为STA-MCA搭桥术后长期随访的主要无创检查方法。围手术期时STA流量明显升高,至术后1年时流量较围手术期减低,但仍显著高于正常水平,达到"稳态"。STA/ECA PI及RI比值可作为评估桥血管通畅性的间接指标。Objective To evaluate the hemodynamic changes and short-term(one year)outcomes after superficial temporal artery(STA)-middle cerebral artery(MCA)bypass by vascular ultrasonography.Methods Operation group included a total of 41 hemispheres of 38 patients who underwent STA-MCA bypass for severe stenosis or occlusion of MCA or severe stenosis or occlusion of internal carotid artery(ICA),or Moyamoya disease at Xuanwu Hospital between August 2017 and June 2020.The following examinations were performed in all patients:cranial MRI,CT perfusion imaging,and cerebral angiography.All of the patients were retrospectively followed up for one year postsurgery.Normal group included a total of 40 hemispheres of 20 healthy people who had been examined by vascular ultrasonography of carotid artery and intracranial artery.Inner diameter,peak systolic velocity(PSV),end-diastolic velocity(EDV),mean velocity(MV),resistance index(RI),pulsatility index(PI)and flow of STA,PSV,EDV,MV,PI,RI of external carotid artery(ECA)and PSV,EDV,MV,PI,RI of MCA at 1 week,6 months and 12 months after STA-MCA bypass of operation group were compared with normal group.Results①Inner diameter,PSV,MV and flow of STA were increased significantly in operation group at 1 week,6 and 12 months than normal group(all P<0.05).The flow of STA was decreased significantly from 1 week to 12 months after operation(all P<0.05),but Inner diameter,PSV and MV were only decreased gradually from 1 week to 12 months after operation(all P>0.05).②STA/ECA PI and RI decreased significantly after operation compared with normal group(all P<0.01).Conclusions Vascular ultrasonography is a non-invasive examination which can objectively evaluate the extracranial and intracranial hemodynamic changes after STA-MCA bypass,and provide reference effectiveness of the operation.The flow of STA has decreased gradually from 1 week to 12 months after operation to achieve the homeostasis,but it is still higher than normal.STA/ECA PI and RI can be a steady indirect pointer to show the fluency of

关 键 词：颞浅动脉-大脑中动脉搭桥术 烟雾病 脑血管病 彩色多普勒超声 血流动力学 

分 类 号：R651.12[医药卫生—外科学]