超声在STA-MCA搭桥术治疗烟雾病中的评估价值

Evaluation value of ultrasound in superficial temporal artery-middle cerebral artery anastomosis in treating moyamoya disease

摘要:

目的 应用超声技术对行颞浅动脉（superficial temporal artery，STA）-大脑中动脉（middle cerebral artery，MCA）搭桥术的烟雾病（moyamoya disease，MMD）患者进行术前、术后评估，探讨超声在早期预测手术成功率方面的临床价值。方法 选取2018年7月至2020年9月在空军军医大学第二附属医院行MMD搭桥术的患者28例，分别于术前1~3 d、术后4~7 d进行STA主干、顶支、额支内径及血流动力学参数检测；MCA远段及近段，大脑后动脉（posterior cerebral artery，PCA）血流动力学参数检测；术后桥血管内径及血流动力学参数进行检测。血流动力学参数测量包括收缩期峰值血流速度（systolic peak flow velocity，V_s）、舒张期末血流速度（diastolic end flow velocity，V_d）、平均血流速度（mean flow velocity，V_m）、搏动指数（pulse index，PI）、阻力指数（resistance index，RI）。所有患者根据术后6个月至1年经数字减影血管造影（digital saubtraction angiograph，DSA）检查结果分为搭桥通畅组与不通畅组，统计分析2组检测血管血流动力学术前术后之间的差异。结果 所有患者术后6个月至1年内行DSA检查，证实86%（24/28）吻合血管通畅，手术成功。搭桥通畅组中92%（22/24）的患者术后与术前相比，STA、桥血管内径明显增宽，V_s、V_m、V_d明显升高，PI值明显减低，频谱呈“颅内动脉化”改变，且MCA远段血流反向，差异有统计学意义（P<0.05）；MCA近段、PCA血流参数术前术后相比无统计学差异。搭桥通畅组与不通畅组之间，通畅组STA和桥血管内径较不通畅组明显增宽，2组间差异有统计学意义（P<0.05）；通畅组STA和桥血管V_m、V_s、V_d高于不通畅组，PI值低于不通畅组，差异有统计学意义（P<0.05）。绘制ROC曲线，术后STA内径变化率≥37%、STA-PI≤1.26是预测手术成功的最佳截断值。结论 MMD患者在进行STA-MCA搭桥术时，应用超声技术术前探查STA内径及血流参数，术后探查STA内径变化率及与桥血管的血流频谱PI值，在早期预测吻合口血管是否通畅、手术是否成功方面具有潜在的临床应用价值。

Abstract:

Objective To conduct the preoperative and postoperative evaluation of moyamoya disease（MMD）patients undergoing superficial temporal artery（STA）-middle cerebral artery（MCA）anastomosis using ultrasound technique，and to investigate the clinical value of ultrasound in early prediction of surgical success rate.Methods A total of 28 patients who underwent STA-MCA anastomosis in The Second Affiliated Hospital of Air Force Medical University from July 2018 to September 2020 were selected. The internal diameters and hemodynamic parameters of main branch，top branch and frontal branch of STA trunk，the distal and proximal MCA and the posterior cerebral artery（PCA） were detected 1-3 days before and 4-7 days after surgery. The internal diameter and hemodynamic parameters of bridging vessels were detected after surgery. Hemodynamic parameters were measured including systolic peak flow velocity（V_s），diastolic end flow velocity（V_d），mean flow velocity（V_m），pulse index（PI） and resistance index（RI）. All patients were divided into two groups according to the results of 6 months to 1 year digital saubtraction angiograph（DSA）examination after surgery，and the differences between the two groups were statistically analyzed.Results All patients underwent DSA examination within 6 months to 1 year after surgery，which confirmed that 86%（24/28）of the anastomosis vessels were patency，and the operation was successful. Compared with preoperation，92%（22/24）of patients in the patency group showed the diameter of STA and bridge vascular was significantly widened，the V_s，V_m and V_d were significantly increased，PI value was significantly decreased after surgery，“intracranial arterialization” change appeared in spectrum，and reverse flow occurred in MCA distal segment（all P<0.05）. There were no statistically significant differences in the proximal segment of MCA and PCA blood flow parameters before and after surgery. The diameter of STA and bridge vascular in the patency group was significantly wider than that in the non-patency group（P<0.05）. The V_s，V_m and V_d values of STA and bridging vascular in the patency group were higher than those in non-patency group，and the PI value was lower than that in the non-patency group，with significant differences between the two groups（P<0.05）. ROC curve were showed that the change rate of STA diameter after surgery was greater than or equal to 37%，and the STA-PI value was less than or equal to 1.26，which were the best cut-off values to predict the success of surgery.Conclusion When MMD patients are undergoing STA-MCA anastomosis surgery，ultrasound technology can beused to detect the internal diameters and blood flow parameters of STA before surgery，and the internal diameter change rate and the PI of STA and bridge vessels after surgery，which has potential clinical application value for early prediction of whether the anastomotic vessels are patency and whether the operation is successful.