摘要
目的探讨术中显微镜下吲哚菁绿荧光造影(ICGA)技术在内镜颅底重建手术中预测带蒂鼻中隔黏膜瓣活性的价值。方法选取河南省人民医院2019年1月至2020年6月行内镜经鼻颅底手术且应用带蒂鼻中隔黏膜瓣行颅底重建患者36例,颅底重建时切换为显微镜,对鼻中隔黏膜瓣进行ICGA,记录术中黏膜瓣蒂部和体部显影,将显影程度分为强显影、中显影、弱显影和无显影,强显影和中显影认为显影阳性,弱显影和无显影认为显影阴性。术后72 h内行垂体对比增强磁共振检查,记录黏膜瓣有无强化;术后1~2周行内镜鼻腔探查明确黏膜瓣活性,记录患者术后有无脑脊液鼻漏。采取χ^2检验分析术中黏膜瓣吲哚菁绿(ICG)荧光显影与术后黏膜瓣磁共振成像(MRI)强化、黏膜瓣坏死和脑脊液漏的关联,组间比较采用t检验。结果术中黏膜瓣ICG显影与术后黏膜瓣MRI强化的关系:蒂部和体部均显影18例,术后MRI黏膜瓣全部强化(100%),ICG蒂部显影10例,术后9例黏膜瓣MRI强化;ICG体部显影5例,术后4例黏膜瓣MRI强化;ICG蒂部和体部均无显影3例,术后1例黏膜瓣MRI强化,差异有统计学意义(χ^2=12.038,P<0.05)。术中黏膜瓣ICG显影与术后黏膜瓣坏死的关系:蒂部和体部ICG荧光显影亚组,黏膜瓣坏死为0例;ICG蒂部显影亚组,1例出现黏膜瓣坏死;ICG体部显影亚组,1例出现黏膜瓣坏死;ICG蒂部和体部无显影亚组,2例出现黏膜瓣坏死,差异有统计学意义(χ^2=12.038,P<0.05)。术中黏膜瓣ICG显影与术后脑脊液漏的关系:蒂部和体部ICG荧光显影亚组,2例出现脑脊液漏;ICG蒂部显影亚组,2例出现脑脊液漏;ICG体部显影亚组,术后脑脊液漏0例;ICG蒂部和体部无显影亚组,2例术后出现脑脊液鼻漏,差异无统计学意义(χ^2=6.880,P>0.05)。结论显微镜下术中ICGA带蒂鼻中隔黏膜瓣灌注成像是可行的,黏膜瓣蒂部和体部均显影与术后黏膜瓣MRI增强和黏膜瓣坏死有很�
Objective To investigate predictive value of indocyanine green(ICG)fluorescence angiography for vascular pedicle nasoseptal flap viability in endoscopic endonasal reconstructive surgery of skull base under the intraoperative microscopy.Methods From January 2019 to June 2020,36 patients from Henan Provincial People′s Hospital undergoing endoscopic endonasal skull base surgery and skull base reconstruction with vascular pedicle nasoseptal flap were selected.The ICG near-infrared fluorescence microscopy was performed during endoscopic endonasal skull base reconstructive surgery after resection of skull base tumors.Intraoperative and postoperative data were collected regarding enhancement of the flap body and pedicle.The enhancement of each flap body and pedicle was rated qualitatively as high,moderate,low,or no enhancement.High and moderate enhancement was grouped together as positive enhancement,and low and no enhancement as no enhancement.Postoperatively,flap perfusion was evaluated via magnetic resonance imaging(MRI)-contrast enhancement within 72 h,in addition to cerebrospinal fluid leak.Results Associations between intraoperative ICG flap enhancement and MRI enhancement were that both the body and pedicle enhanced with ICG in 18 patients,the rate of postoperative MRI contrast enhancement was 100.0%,the pedicle enhanced with ICG in 10 patients,the rate of postoperative MRI contrast enhancement was 90.0%,the body enhanced with ICG in 5 patients,the rate of postoperative MRI contrast enhancement was 80.0%,one of 3 patients without ICG enhancement developed postoperative MRI contrast enhancement.The difference was statistically significant(χ^2=12.038,P<0.05).Associations between intraoperative ICG flap enhancement and flap necrosis were that the subgroup of both the body and pedicle enhanced with ICG,the rate of flap necrosis was 0%,the subgroup of pedicle enhanced with ICG,the rate of flap necrosis was 10.0%,the subgroup of body enhanced with ICG,the rate of flap necrosis was 20.0%,two of 3 patients without ICG
作者
王玉社
郭华超
马真
温硕
王甲光
王勇
Wang Yushe;Guo Huachao;Ma Zhen;Wen Shuo;Wang Jiaguang;Wang Yong(Department of Neurosurgery,Henan Provincial People′s Hospital(Henan University People′s Hospital,Zhengzhou University People′s Hospital),Zhengzhou 450003,China)
出处
《中华实验外科杂志》
CAS
北大核心
2021年第1期168-171,共4页
Chinese Journal of Experimental Surgery
基金
河南省医学科技攻关计划省部共建青年项目(SB201902027)。
关键词
吲哚菁绿
显微镜
内镜经鼻手术
Indocyanine green
Microscopy
Endoscopy endonasal surgery
