彩色多普勒超声在颅内动静脉畸形切除术中的应用

【】　目的　探讨颅内动静脉畸形切除术中彩色多普勒超声检查的应用价值与预后的关系。　方法　在显微外科手术的基础上，将65例动脑静脉畸形患者随机分为A、B两组，A组34例动静脉畸形患者在术中接受术中超声检查，确定其畸形血管团的数目、位置、深度、大小、范围及其与周边组织结构的关系，探查供血动脉及引流静脉的数目及走行，以确定动、静脉畸形的位置、手术切除范围及切除术后是否有畸形血管残留；B组31例行常规手术，比较两组之间的差异。　结果　术中彩色多普勒超声能清晰的显示动静脉畸形的情况，两组经手术完整切除动静脉畸形率、再出血率、术后7dGlasgow昏迷评分及预后差异均有统计学意义（P<0.05）。　结论　术中实时彩色多普勒超声能对脑动静脉畸形准确定位，并可判定脑动静脉畸形的血供模式及残余情况，减少脑组织损伤及降低手术并发症的发生，提高了手术安全性及治疗效果。【Abstract】　Objective　ToexploretheapplicationofthecoloredDopplerultrasonographyintheexcisionofintracranialarteriovenousmalformation(AVM)todeterminethelocationofthelesionandthecompletenessoftheresection,andtoevaluatetheclinicalvalueofintraoperativeultrasonographyinthediagnosis,treatmentandtherelationtotheprognosisofpatients.　Methods　Atotalof65patientswithbrainAVMwererandomlydividedintogroupAandB.Themicrosurgerywasperfromedonthepatients.Intraoperativeultrasoundwasperformedonthe34patientsingroupAtothenumbers,location,depth,sizeofdifferentmalformationvascularclumpsrelationshipofthearteriovenousmalformationwithsurroundingtissues.WhilethepateintsingroupBunderwenttheroutinesurgery.Thedifferencebetweenthetwogroupswerecompared.　Results　TheconditionoftheAVMwereclearlyrevealedbyintraoperativeultrasonography.AlloftheintracranialAVMingroupAwerecompletelyremoved.ThedifferenceinrehaemorrhagiaandpostoperativeGlasgowcomascalescoreofsevendaybetweenthetwogroupswerestatisticallysignificant(P<0.05).　Conclusions　IntraoperativecolorDopplerultrasounographyintheresectionofintracranialAVMcouldaccuratelocalizethelesions,identifyvascularanatomyoftheAVMvascularballsandthecompletenessofresection.Theparametersincludingresistanceindexofthevesselsmayidentifytheabnormalvesselsandreducetheoperativecomplicationsandbraintissuedamage,whichimprovethesafetyandefficacyofthetherapeuticeffect.