摘要
目的通过观察脑动脉瘤夹闭，载瘤动脉及主要分支动脉闭锁或狭窄，对比研究手术显微镜下吲哚菁绿血管造影（ICGA）与术后脑血管造影（DSA），评价ICGA在动脉瘤夹闭手术中的应用价值。方法对101例颅内动脉瘤患者的113枚动脉瘤常规手术夹闭，在手术中应用整合近红外光（NIR）吲哚菁绿（ICG）血管造影的手术显微镜新技术，将ICG染料经静脉单次注射到达NIR照射术野，观察诱发出的ICG荧光影像。将ICG造影证实载瘤动脉通畅度、穿通支和动脉瘤夹闭状态与术后复查DSA对比。结果101例患者动脉瘤夹闭前后行荧光造影219次，除3例外，ICGA图像质量和分辨率良好，可以实时显示脑循环。ICGA可以提供脑动脉，毛细血管和静脉与手术后DSA对比。3例术中ICGA提供有意义的手术信息，调整了动脉瘤夹。101例动脉瘤手术中ICGA与手术后DSA符合，无动脉瘤瘤蒂残留，载瘤动脉畅通。结论手术显微镜结合ICGA在手术中可以提供动脉瘤夹闭和载瘤动脉情况，实时简便，重复性好，可以作为术中多普勒超声和术中DSA补充，可能成为动脉瘤术中血管造影的常规技术。
Objective To evaluate the effects of surgical microscope-based indocyanine green videoangiography （ICGA） in aneurysm surgery and compare the values of ICGA and postoperative digital subtraction angiography （ DSA）. Methods 101 patients with intracranial aneurysm underwent clipping of 113 aneurysms. A microscope-integrated light source containing infrared excitation light illuminated the operating field. The dye ICG was injected intravenously, and the intravascular fluorescence was recorded by a video camera attached to the microscope with optical filtering to block ambient and laser light for collection of only ICG-induced fluorescence. All patients underwent DSA 6 - 13 days post-operatively. The results of patency of parent, branching, and perforating arteries and documentation of aneurysm obliteration shown by ICGA and DSA were compared. Result 219 times of ICGA was performed in these 101 patients with excellent image quality and resolution, allowing intra-operative real-time assessment of the cerebral circulation. The ICG angiographic results could be divided into arterial, capillary, and venous phases, comparable to those observed with DSA. In all cases, the postoperative angiographic results corresponded to the intraoperative ICG video angiographic findings. In 3 cases, the information provided by intraoperative ICGA significantly changed the surgical procedure. Conclusion Simple and repeatable, microscope-based ICGA provides real-time information about vessels and aneurysm sac. This technique may be useful during routine aneurysm surgery as an adjunct to intraoperative microvascular Doppler ultrasonography and DSA.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第3期146-150,共5页
National Medical Journal of China
关键词
动脉瘤
吲哚菁绿
手术中造影
Intracranial aneurysm
Indocyanine green （ICG）
Intraoperative angiography
