吲哚菁绿荧光血管造影在颅内动脉瘤手术中的应用
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摘要
目的探讨吲哚菁绿(ICG)荧光血管造影在颅内动脉瘤手术中的应用价值。方法选择2013年8月至2017年2月自贡市第一人民医院收治的24例颅内动脉瘤患者为研究对象,患者均行动脉瘤夹闭术,术中给予ICG荧光血管造影,术后随访3～68个月,记录患者的预后。结果 ICG荧光血管造影能明确辨认动脉瘤大小、瘤体指向,术中确认动脉瘤颈残留3例,载瘤动脉分支血管闭塞2例,穿通支血管误夹1例。供血动脉阻断后引流静脉的最大荧光强度显著低于动脉瘤切除前(P <0. 05),动脉瘤切除后引流静脉的最大荧光强度显著低于供血动脉阻断后(P <0. 05)。动脉瘤切除前和供血动脉阻断后引流静脉显影延迟时间比较差异无统计学意义(P> 0. 05),动脉瘤切除后引流静脉显影延迟时间显著长于动脉瘤切除前和供血动脉阻断后(P <0. 05)。患者均顺利完成手术,无手术相关死亡病例,术后随访期间死亡5例(20. 8%,5/24)。结论术中ICG荧光血管造影在颅内动脉瘤手术中具有重要的应用价值,能够提供高质量、高分辨率的图像,提高手术安全性,改善患者预后。
Objective To explore the application value of intraoperative indocyanine green( ICG) fluorescein angiography in the intracranial aneurysm surgery. Methods Twenty-four intracranial aneurysm patients in Zigong First People's Hospital from August 2013 to February 2017 were selected as subjects. All patients were given aneurysm neck clipping,and were given intraoperative ICG fluorescence angiography. The patients were followed-up for 3-68 months and the prognosis were recorded. Results The size and direction of the aneurysms could clearly identify by ICG fluorescein angiography. There were 3 cases of residual aneurysm neck surgery,2 cases of parent artery branch vascular occlusion,1 case of arteries inadvertent occlusion. The maximum fluorescence intensity of the drainage vein after the blockade of the feeding artery was significantly lower than that before the aneurysm resection( P < 0. 05),and the maximum fluorescence intensity of the drainage vein after the aneurysm resection was significantly lower than that after the blockade of the feeding artery( P < 0. 05). There was no significant difference in the delayed time of the drainage vein development before aneurysm resection and after the blockade of the feeding artery( P > 0. 05); the delayed time of the drainage vein development after aneurysm resection was significantly longer than that before aneurysm resection and after the blockade of the feeding artery( P < 0. 05). All patients completed the operation successfully,there was no surgery related deaths,and there were 5 cases( 20. 8%) dead during the followed up period. Conclusion The intraoperative ICG fluorescein angiography has important application value in intracranial aneurysm surgery,it can provide high quality and high resolution images,and improve operation safety and the prognosis of patients.
Objective To explore the application value of intraoperative indocyanine green( ICG) fluorescein angiography in the intracranial aneurysm surgery. Methods Twenty-four intracranial aneurysm patients in Zigong First People's Hospital from August 2013 to February 2017 were selected as subjects. All patients were given aneurysm neck clipping,and were given intraoperative ICG fluorescence angiography. The patients were followed-up for 3-68 months and the prognosis were recorded. Results The size and direction of the aneurysms could clearly identify by ICG fluorescein angiography. There were 3 cases of residual aneurysm neck surgery,2 cases of parent artery branch vascular occlusion,1 case of arteries inadvertent occlusion. The maximum fluorescence intensity of the drainage vein after the blockade of the feeding artery was significantly lower than that before the aneurysm resection( P < 0. 05),and the maximum fluorescence intensity of the drainage vein after the aneurysm resection was significantly lower than that after the blockade of the feeding artery( P < 0. 05). There was no significant difference in the delayed time of the drainage vein development before aneurysm resection and after the blockade of the feeding artery( P > 0. 05); the delayed time of the drainage vein development after aneurysm resection was significantly longer than that before aneurysm resection and after the blockade of the feeding artery( P < 0. 05). All patients completed the operation successfully,there was no surgery related deaths,and there were 5 cases( 20. 8%) dead during the followed up period. Conclusion The intraoperative ICG fluorescein angiography has important application value in intracranial aneurysm surgery,it can provide high quality and high resolution images,and improve operation safety and the prognosis of patients.
引文
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[15] NOMI N,OTA M,FUKUMURA M,et al. Indocyanine greenangiography findings of cystoid macular edema secondarytopaclitaxel therapy[J]. Jpn J Ophthalmol,2018,62(2):163-167.
[16] COSCAS G,LUPIDI M,COSCAS F,et al. Optical coherencetomography angiography in healthy subjects and diabetic patients[J]. Ophthalmologica,2018,239(2/3):61-73.
[17] LIN M,ANESI S D,MA L,et al. Characteristics and visual outcomeof refractory retinal vasculitis associated with antineutrophilcytoplasmantibody-associated vasculitides[J]. Am J Ophthalmol,2018,4(187):21-33.
[18] ASAHI M G,CHON A T,GALLEMORE E,et al. Photodynamictherapy combinedwithantivascular endothelial growth factortreatment for recalcitrant chroniccentral serous chorioretinopathy[J]. Clin Ophthalmol,2017,21(11):2051-2056.
[19] KIM J H,CHANG Y S,LEE D W,et al. Quantification of retinalchangesafter resolution of submacular hemorrhage secondary topolypoidalchoroidalvasculopathy[J]. Jpn J Ophthalmol,2018,62(1):54-62.
[20] ZHANG B,LI N,KANG J,et al. Adaptive optics scanninglaserophthalmoscopy in fundus imaging,a review and update[J].Int J Ophthalmol,2017,10(11):1751-1758.
[21] HANYUDA N,AKIYAMA H,SHIMODA Y,et al. Differentfilling-patterns of the choriocapillaris in fluorescein and indocyaninegreen angiography in primate eyes under elevated intraocularpressure[J]. Invest Ophthalmol Vis Sci,2017,58(13):5856-5861.
[22] EPSTEIN N E. Cerebrospinal fluid drains reduce risk of spinal cordinjury forthoracic/thoracoabdominal aneurysm surgery:areview[J]. SurgNeurol Int,2018,23(9):48-58.
[2]缪洪平,唐俊,牛胤,等.吲哚菁绿荧光血管造影在颅内动脉瘤夹闭术中的应用[J].重庆医学,2015,44(27):3785-3787.
[3] KURIYAMA M,YANO A,YOSHIDA Y,et al. Reconstruction using adivided latissimus dorsimuscleflap after conventional posterolateralthoracotomy and the effectiveness ofindocyaninegreen-fluorescenceangiography to assess intraoperative blood flow[J]. Surg Today,2016,46(3):326-334.
[4]王波,卜祥梅,徐超,等.颈内动脉床突上段血泡样动脉瘤完全夹闭后短期内复发1例报告[J].山东医药,2016,56(15):108-109.
[5] ELIAVA S S,SHEKHTMAN O D,PILIPENKO Y V,et al.Intraoperativeindocyanine green fluorescence angiography insurgeryof brain aneurysms:the first experience with using the techniqueandliteraturereview[J]. Zh Vopr NeirokhirIm N N Burdenko,2015,79(1):33-41.
[6] LANE B,BOHNSTEDT B N,COHEN-GADOL A A. A prospectivecomparative study ofmicroscope-integrated intraoperative fluoresceinand indocyaninevideoangiographyfor clip ligation of complexcerebral aneurysms[J]. J Neurosurg,2015,122(3):618-626.
[7] MURAI Y,MIZUNARI T,KOKETSU K,et al. Fluorescenceangiography with temporary occlusion to confirm the distal artery:technical notes[J]. Neurol Med Chir(Tokyo),2015,55(8):683-688.
[8]张国锋,唐尤佳,高翔,等.吲哚菁绿荧光血管造影在颅内前循环动脉瘤夹闭术中的应用[J].中华神经医学杂志,2016,15(9):923-927.
[9] YOSHIOKA H,KINOUCHI H,NISHIYAMA Y,et al. Advantage ofmicroscope integrated for both indocyanine green and fluoresceinvideoangiography on aneurysmal surgery:case report[J]. NeurolMed Chir(Tokyo),2014,54(3):192-195.
[10]叶新运,张震宇,黄锦庆,等.吲哚菁绿血管造影在颅内动脉瘤夹闭术中的临床应用76例报告[J].中华神经外科疾病研究杂志,2015,14(5):461-462.
[11] TAN C S,LIM L W,NGO W K,et al. EVEREST report 5:clinicaloutcomes and treatment response of polypoidalchoroida-lvasculopathy subtypes in a multicenter,randomized controlledtrial[J]. Invest Ophthalmol Vis Sci,2018,59(2):889-896.
[12] HUA L,LIN B,HONG J,et al. Clinical research on one-thirddose verteporfin photodynamic therapy in the treatment ofchroniccentral serous chorioretinopathy[J]. Eur Rev MedPharmacol Sci,2018,22(2):278-284.
[13] XIROU T,KABANAROU S A,GKIZIS I,et al. Chronic centralserous chorioretinopathy-like maculopathy as atypical presentationof chorioretinalfolds[J]. Case Rep Ophthalmol,2017,8(3):568-573.
[14] TSUJIKAWA A,AKAGI-KURASHIGE Y,YUZAWA M,et al.Baseline data froma multicenter,5-year,prospective cohort studyof Japanese age-related maculardegeneration:an AMD2000 report[J]. Jpn J Ophthalmol,2018,62(2):127-136.
[15] NOMI N,OTA M,FUKUMURA M,et al. Indocyanine greenangiography findings of cystoid macular edema secondarytopaclitaxel therapy[J]. Jpn J Ophthalmol,2018,62(2):163-167.
[16] COSCAS G,LUPIDI M,COSCAS F,et al. Optical coherencetomography angiography in healthy subjects and diabetic patients[J]. Ophthalmologica,2018,239(2/3):61-73.
[17] LIN M,ANESI S D,MA L,et al. Characteristics and visual outcomeof refractory retinal vasculitis associated with antineutrophilcytoplasmantibody-associated vasculitides[J]. Am J Ophthalmol,2018,4(187):21-33.
[18] ASAHI M G,CHON A T,GALLEMORE E,et al. Photodynamictherapy combinedwithantivascular endothelial growth factortreatment for recalcitrant chroniccentral serous chorioretinopathy[J]. Clin Ophthalmol,2017,21(11):2051-2056.
[19] KIM J H,CHANG Y S,LEE D W,et al. Quantification of retinalchangesafter resolution of submacular hemorrhage secondary topolypoidalchoroidalvasculopathy[J]. Jpn J Ophthalmol,2018,62(1):54-62.
[20] ZHANG B,LI N,KANG J,et al. Adaptive optics scanninglaserophthalmoscopy in fundus imaging,a review and update[J].Int J Ophthalmol,2017,10(11):1751-1758.
[21] HANYUDA N,AKIYAMA H,SHIMODA Y,et al. Differentfilling-patterns of the choriocapillaris in fluorescein and indocyaninegreen angiography in primate eyes under elevated intraocularpressure[J]. Invest Ophthalmol Vis Sci,2017,58(13):5856-5861.
[22] EPSTEIN N E. Cerebrospinal fluid drains reduce risk of spinal cordinjury forthoracic/thoracoabdominal aneurysm surgery:areview[J]. SurgNeurol Int,2018,23(9):48-58.