中国临床解剖学杂志 ›› 2022, Vol. 40 ›› Issue (3): 338-341.doi: 10.13418/j.issn.1001-165x.2022.3.17

• 临床研究 • 上一篇    下一篇

桡动脉提取在高流量脑血管搭桥手术中的应用

李琪1, 孙杨2, 王本琳1, 佟小光1, 3*   

  1. 1. 南开大学医学院,  天津   300071;    2.天津医科大学神经内外科及神经康复临床医学院,  天津    300070
    3.天津市环湖医院神经外科,  天津   300350
  • 收稿日期:2021-09-13 出版日期:2022-05-25 发布日期:2022-06-02
  • 通讯作者: 佟小光,教授,主任医师,博士生导师,E-mail:tongxiaoguanghh@163.com
  • 作者简介:李琪(1983-),男,天津人,在读博士,主要从事颅底及脑血管疾病解剖与临床研究,E-mail:liqi8308@163.com
  • 基金资助:
    天津市科技计划项目(18ZXDBSY00180)

Application of radial artery extraction technique in high-flow cerebrovascular bypass surgery

Li Qi1, Sun Yang2, Wang Benlin1, Tong Xiaoguang1,3*   

  1. 1. School of Medicine, Nankai University, Tianjin 300071, China; 2. Clinical College of Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China; 3. Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300350, China
  • Received:2021-09-13 Online:2022-05-25 Published:2022-06-02

摘要: 目的 探讨桡动脉提取技术在高流量脑血管搭桥中的应用。  方法 回顾性纳入2015年1月至2021年6月天津市环湖医院32例以桡动脉为桥血管行高流量脑血管搭桥手术患者,统计桡动脉所取长度及内径、收缩期峰值流速、舒张末期流速、内膜厚度、阻力系数等相关参数,应用影像学及临床数据评估手术效果,术后桥血管通畅率及并发症等有效性、安全性指标。  结果 本组患者无围手术期死亡,32例患者共搭桥32根,所取桡动脉平均长度(20.20±2.06)cm,近心端内径平均(2.41±0.28)mm,远心端内径平均(2.28±0.42)mm,各项参数及Allen's试验、造影等检查提示所取桡动脉通畅性良好,满足高流量搭桥需要,本研究中提取桡动脉搭桥技术成功率100%,术后随访影像学检查示搭桥通畅,患者均未出现因桥血管痉挛而导致的缺血性卒中,前臂及腕关节肌力较术前未下降,4例患者出现前臂外侧皮神经及桡神经浅支损伤症状并于3月内缓解。  结论 提取桡动脉技术应用于脑血管搭桥具有安全性、有效性,该技术配合高流量脑血管搭桥术在颅底肿瘤、复杂脑血管疾病等领域具有广阔的应用前景。

关键词: 桡动脉提取,  高流量脑血管搭桥,  有效性,  安全性

Abstract: Objective    To explore the application of extraction technology with radial artery in the high-flow cerebrovascular bypass surgery. Methods Thirty-two patients of high-flow bypass surgery with radial artery as a bridging vessel admitted to the Department of Neurosurgery, Tianjin HuanHu Hospital from January 2015 to June 2021 were enrolled retrospectively. The length, internal diameter, peak systolic velocity, end diastolic velocity, intima-media thickness and resistance index of radial artery were measured.  The imaging data and medical records were also utilized to assess the safety and efficacy including surgery effect, postoperative complication and patency rate of the radial artery.    Results     No perioperative death was found in this study. Thirty-two patients had 32 bypass grafts. The average radial artery length was (20.20±2.06) cm. The average internal diameter of the proximal end was (2.41±0.28) mm, as the average inner diameter of the distal end was t (2.28±0.42) mm. These examinations combined with Allen’s test and angiography indicated that the radial arteries were selected with good patency and suitable for high-flow bypass surgery. In this study, the bypass technique had a 100% success rate. Postoperative and follow-up imaging findings demonstrated graft vessel patency. None of the patients had suffered ischemic stroke due to radial artery spasm. The muscle strength of forearm and wrist showed no drop compared with that before operation. Postoperative 4 cases showed injury symptoms of lateral forearm cutaneous nerve and superficial branch of radial nerve, and relieved within 3 months. Conclusions Application of extraction technology with radial artery in cerebrovascular bypass surgery was demonstrated good safety and efficacy. This technique with high-flow cerebrovascular bypass surgery has wide application prospects in the cranial base tumors, complex cerebrovascular disease and other fields.

Key words: Radial arterial extraction,   High-flow cerebrovascular bypass,   Efficacy,  Safety

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