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目的:探讨在经颅彩色多普勒(TCD)辅助下,行肿瘤合并颈动脉切除术前,颈动脉压迫训练时脑血流动力学改变的临床价值。方法:采用TCD为14例手术患者经颞窗检测,观察在阻断患侧颈动脉后双侧ACA(大脑前动脉),MCA(大脑中动脉)的血流速度变化和W illis环开放情况。结果:通过颈动脉压迫训练,DSA(数字减影脑血管造影)和TCD检测发现9例病人(64.3%,9/14)W illis环代偿能力不良,在接受颈动脉压迫训练2~6周后,TCD检测其开放状态和脑侧枝循环建立良好,患侧ACA、MCA血流速度基本达到阻断前水平,颈动脉压迫训练前、后患侧颈动脉阻断时TCD检测对照ACAt=19.278,P<0.05;MCAt=22.278,P<0.05,ACA和MCA训练前后颈动脉阻断时比较差异有显著性,符合颈动脉切除术标准。14例随访1年以上未见肿瘤复发,无1例手术死亡或脑血管并发症。结论:TCD是一种无创伤,重复性好,安全可靠,易被接受的脑血流监测评估手段,对肿瘤合并颈动脉切除术尤为重要。
Objective: To investigate the clinical value of cerebral hemodynamic changes before carotid artery compression training with the aid of transcranial color Doppler (TCD) in patients with tumor and carotid artery resection. Methods: TCD was performed in 14 cases of patients undergoing temporal window examination to observe changes of blood flow velocity and W illis ring in bilateral ACA (anterior cerebral artery) and MCA (middle cerebral artery) after blocking the ipsilateral carotid artery. Results: Nineteen patients (64.3%, 9/14) had poor compensatory ability of W illis ring through DSA (digital subtraction angiography) and TCD examination. After receiving carotid artery compression training for 2 to 6 weeks TCD was used to detect the open state and the collateral circulation was established. The blood flow velocity of ACA and MCA in the affected side reached the level of pre-blocking blood flow, the ACAt of TCD was 19.278 and the ACAt was 19.278 before and after carotid artery compression training <0.05; MCAt = 22.278, P <0.05. There were significant differences in carotid artery occlusion between ACA and MCA before and after training, which met the criteria of carotid resection. No tumor recurrence was found in 14 cases of follow-up of more than 1 year, no case of surgical death or cerebrovascular complications. Conclusion: TCD is a noninvasive, reproducible, safe, reliable and easily accepted method of cerebral blood flow monitoring and evaluation, which is particularly important for tumor combined with carotid artery resection.