CAJ | 학술논문

目的探讨经口腔超声检查颈内动脉(ICA)近段狭窄或闭塞时颅外远段管腔变化的应用价值.方法病变组110例,高频线阵探头扫查ICA近段狭窄≥50％或闭塞；正常对照组32例.高频线阵探头检测颈总动脉(CCA)及ICA近段,经口腔超声检测ICA颅外远段,观察管腔状况、彩色血流表现及频谱形态变化,测量管径、收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)及PSVICA/PSVCCA值.超声检查结束后2周内完成数字减影血管造影术(DSA)检查,并与超声结果对照.结果病变组经口腔超声扫查成功率为92.7％,正常对照组经口腔超声扫查成功率为93.8％.从正常组～接近闭塞组ICA远段管径、PSV测值逐渐减小,相邻两组间比较差异有统计学意义(P＜0.05),但接近闭塞组与完全闭塞组管径测值相近,差异无统计学意义(P＞0.05)；完全闭塞组80％管腔内可见血栓回声.20％管腔内无血栓,可见有暗淡彩色血流,并录及低速动脉频谱.ICA远段频谱形态在接近闭组均呈“小慢波”或“单峰状”,在狭窄≥70％～接近闭塞组76.7％频谱毛刺或呈“小慢波”状,在狭窄50％～69％时30.8％频谱毛刺,其余频谱形态正常.结论经口腔超声能获得ICA近段狭窄或闭塞时颅外远段管腔及血流变化的信息,与高频线阵探头联合应用可扫查ICA颅外全段,具有一定的临床应用价值.
목적 탐토경구강초성검사경내동맥(ICA)근단협착혹폐새시로외원단관강변화적응용개치.방법 병변조110례,고빈선진탐두소사ICA근단협착≥50％혹폐새；정상대조조32례.고빈선진탐두검측경총동맥(CCA)급ICA근단,경구강초성검측ICA로외원단,관찰관강상황、채색혈류표현급빈보형태변화,측량관경、수축기봉치혈류속도(PSV)、서장말기혈류속도(EDV)급PSVICA/PSVCCA치.초성검사결속후2주내완성수자감영혈관조영술(DSA)검사,병여초성결과대조.결과 병변조경구강초성소사성공솔위92.7％,정상대조조경구강초성소사성공솔위93.8％.종정상조～접근폐새조ICA원단관경、PSV측치축점감소,상린량조간비교차이유통계학의의(P＜0.05),단접근폐새조여완전폐새조관경측치상근,차이무통계학의의(P＞0.05)；완전폐새조80％관강내가견혈전회성.20％관강내무혈전,가견유암담채색혈류,병록급저속동맥빈보.ICA원단빈보형태재접근폐조균정“소만파”혹“단봉상”,재협착≥70％～접근폐새조76.7％빈보모자혹정“소만파”상,재협착50％～69％시30.8％빈보모자,기여빈보형태정상.결론 경구강초성능획득ICA근단협착혹폐새시로외원단관강급혈류변화적신식,여고빈선진탐두연합응용가소사ICA로외전단,구유일정적림상응용개치.
Objective To investigate the value of transoral carotid ultrasonography (TOCU) in detecting the change of distal extracranial internal carotid artery(ICA) with stenosis and occlusion in its initial segmen.Methods One hundred and ten patients with stenosis at least 50％ or occlusion in the initial segment of ICA diagnosed by high-frequency linear probe were enrolled as case group,while thirty two with healthy carotid arteries as control group.Both of the case and control groups were undergone high-frequency linear probe to examine CCA and the initial segment of ICA,and TOCU to observe their lumen transparency,color Doppler flow display and change of Doppler flow spectrum,even measuring the internal diameter,peak systolic velocity (PSV),end-diastolic velocity(EDV) and PSVICA/PSVCCA ratio,respectively.Digital subtraction angiography (DSA)were performed within two weeks,then compared with ultrasonography.Results 92.7％ patients were performed TOCU examination in case group and 93.8％ in control group.The internal diameter and PSV of the distal extracranial ICA became gradually smaller from control group to near occlusion group,and there were statistical significance between groups ( P ＜0.05),however,near occlusion group had no statistical significance compared with occlusion group( P ＞0.05).There were 80％ arteries having thrombus echo in occlusion group,and the others in this group having no thrombus had gloomy colour flow,even got low-velocity artery spectrum.Doppler flow spectrum of distal extracranial ICA showed characteristics of slow wave or single peak in near occlusion group,and spike shape or slow wave in 76.7 ％ arteries of 70％～near-occlusion stenosis group,but spike shape in 30.8％ arteries of 50％～69％ stenosis group,and the others were normal.Conclusions TOCU is useful for detecting the changing regularity of distal extracranial ICA with stenosis or occlusion in its initial segment and has the value of clinical application in association with high-frequency linear probe.