术中超声在颅内动脉瘤急诊手术中应用价值与预后的关系

目的通过术中超声观察颅内动脉瘤的显示情况,探讨术中超声实时监测及定位病灶、指导手术夹闭的价值。方法在显微外科手术的基础上,将67例脑动脉瘤患者依据手术中有无超声辅助分为超声辅助组35例、常规组32例,术后对两组患者进行了脑血管造影检查,并与术中超声检测结果、术后并发症和疗效进行对照分析。结果超声辅助组患者术中完全夹闭率94.28%,明显高于常规组(71.87%),差异有统计学意义(χ2=6.118,P=0.013)。超声辅助组手术时间(173.79±6.20)min明显短于常规组(189.45±3.70)min;超声辅助组患者术后脑梗死发生率(5.71%)明显低于常规组(31.25%),差异有统计学意义(χ2=7.414,P=0.006);超声辅助组脑脊液恢复正常时间(26.79±3.20)d,明显快于常规组(32.45±1.70)d,差异有统计学意义(P<0.05)。两组死亡率比较差异无统计学意义,超声辅助组术后6个月CSS评分、术后12个月GOS评分均明显优于常规组(Zc=-2.205,P=0.027;Zc=-2.475,P=0.013)。结论在颅内动脉瘤手术中,常规应用术中超声,可准确定位病变、指导手术、缩短手术时间、减少损伤、提高手术的精确性。

Relationship between application value of intraoperative ultrasonography in emergency surgical treatment of cerebralaneurysms and the prognosis

Objective To explore the value of intraoperative ultrasound in localization intracranial aneurys and to guide operation with intraoperative monitorin. Methods Sixty-seven patients with cerebral aneurysms patients were enrolled in this study.The microsurgery were utilize ordinarily. The patients were divided into group A （35 cases with intraoperative ultrasonography） and group B （32 cases without intraoperative ultrasonography）, the patency of the parent vessels and some branching arteries before and after aneurysms clipping with surrounding tissues. The data were analyzed and compared with those of operative microscopic findings of the surgical site and postoperative angiograph. The operative complication and efficacy were compared. Results The complete occlusion rate in group A was 94.28%,which was higher than that in group B（71.87%） ,there was significant difference （ Х^2 =6.118, P=-0.013 ）. The surgery time in group A was （173.79±6.20）min, which was shorter than that in group B （189.45±3.70）min.The incidence of cerebral infarction after operation in group A was obviously lower than that in group B （5.71% vs. 31.25%）, there was significant difference （Х^2 =7.414, P=0.006）. The recover to normalcy time of cerebrospinal fluid in group A was （26.79-＋3.20）d, which was faster than that in group B （32.45±1.70）d. There was no significant difference in death rate between two groups. Within six or twelve months after operation, CSS and GOS in group A were obviously better than those in group B （Zc=-2.205 ,P=-0.027 ;Zc=-2.475 ,P=0.013 ）. Conclusion Intraoperative ultrasound should be applyed routinely in cerebral aneurysm surgery and used to localize cerebral vascular disease, reduce injury, shorten operation time.and improve the accuracy of operation.