术中吲哚菁绿视频血管造影在破裂后交通动脉动脉瘤显微外科夹闭术中的应用  

Application of intraoperative indocyanine green videoangiography in microsurgical clipping of ruptured posterior communicating artery aneurysms

作　　者：王露 颜士卫[2] 刘希光[2] 李爱民[2] Wang Lu;Yan Shiwei;Liu Xiguang;Li Aimin(Jinzhou Medical University,Jinzhou 121000,China;Department of Neurosurgery,Lianyungang First People's Hospital,Lianyungang 222000,China)

机构地区：[1]锦州医科大学,锦州121000 [2]连云港市第一人民医院神经外科,222000

出　　处：《国际脑血管病杂志》2024年第4期266-271,共6页International Journal of Cerebrovascular Diseases

基　　金：江苏省卫健委科研基金项目(ZDA2020018);连云港市卫生科技项目(201910)。

摘　　要：目的探讨吲哚菁绿视频血管造影(indocyanine green videoangiography,ICG-VA)在破裂后交通动脉动脉瘤(posterior communicating artery aneurysm,PCoAA)显微外科夹闭术中的应用价值。方法回顾性纳入2020年1月至2022年7月在连云港市第一人民医院神经外科接受显微外科夹闭术且术中应用ICG-VA的破裂PCoAA患者。术后3 d复查头颅CT判断围手术期并发症。采用CT血管成像(CT angiography,CTA)或数字减影血管造影(digital subtraction angiography,DSA)随访评价ICG-VA的监测效果。应用格拉斯哥转归量表(Glasgow Outcome Scale,GOS)评价临床转归。结果纳入32例破裂PCoAA患者(共38个动脉瘤),男性7例(21.9%),年龄(57.97±8.91)岁(范围40~73岁)。27例(84.4%)为单发性动脉瘤,5例(15.6%)为多发性动脉瘤(4例有2个动脉瘤,1例有3个动脉瘤)。24例(75.0%)无意识障碍或轻度意识障碍,8例(25.0%)存在中重度意识障碍。所有患者均成功夹闭动脉瘤,行ICG-VA共40次。5例多发性动脉瘤患者夹闭前行ICG-VA精准定位载瘤动脉和瘤体部位。初始夹闭后ICG-VA发现3例动脉瘤残留,予调整或补加瘤夹后再次ICG-VA显示残留消除。术后3 d复查CT显示1例发生右侧硬膜下积液伴脑室旁梗死,1例发生硬膜下积液。最终随访时,复查CTA或DSA显示无瘤体残留;18例(56.3%)GOS评分5分,5例(15.6%)4分,9例(28.1%)3分,无植物状态或死亡病例。结论ICG-VA辅助破裂PCoAA显微外科夹闭术可有效避免瘤体残留,临床应用价值明显。ObjectiveTo investigate the application value of indocyanine green videoangiography(ICG-VA)in microsurgical clipping of ruptured posterior communicating artery aneurysms(PCoAA).MethodsPatients with ruptured PCoAA underwent microsurgical clipping and intraoperative ICG-VA at the Department of Neurosurgery,Lianyungang First People's Hospital from January 2020 to July 2022 were included retrospectively.Head CT was reviewed 3 days after operation to determine perioperative complications.CT angiography(CTA)or digital subtraction angiography(DSA)were used to evaluate the monitoring effect of ICG-VA.Glasgow Outcome Scale(GOS)was used to evaluate the clinical outcomes.ResultsThirty-two patients with ruptured PCoAA(a total of 38 aneurysms)were enrolled,including 7 males(21.9%),aged 57.97±8.91 years(range,40~73).Twenty-seven patients(84.4%)had single aneurysm and 5(15.6%)had multiple aneurysms(4 patients with 2 aneurysms and 1 with 3 aneurysms).Twenty-four patients(75.0%)had no or mild consciousness disorder,and 8(25.0%)had moderate to severe consciousness disorder.The aneurysms of all patients were successfully clipped and ICG-VA was performed for a total of 40 times.Five patients with multiple aneurysms underwent precise localization of the parent artery and aneurysmal body using ICG-VA before clipping.After initial clipping,ICG-VA found 3 cases of residual aneurysms.After adjusting or adding aneurismal clips,ICG-VA showed that the residues were eliminated.Three days after the surgery,CT scan showed that 1 patient had right subdural effusion with periventricular infarction,and 1 had subdural effusion.At the final follow-up,CTA or DSA showed no residual aneurysms;the GOS score of 18 patients(56.3%)were 5,5 patients(15.6%)were 4,and 9(28.1%)were 3.There were no cases of vegetative state or death.ConclusionICG-VA assisted microsurgical clipping of ruptured PCoAA can effectively avoid residual aneurysms and the clinical application value is significant.

关 键 词：颅内动脉瘤 动脉瘤 破裂 神经外科手术 监测 手术中 吲哚菁绿 脑血管造影术 治疗结果 

分 类 号：R651.1[医药卫生—外科学]