本文關(guān)鍵詞： 后交通動(dòng)脈 起始部膨大 DSA 破裂　出處：《浙江大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的獲取浙江大學(xué)附屬第一醫(yī)院神經(jīng)外科基于顱腦數(shù)字減影血管造影(Digital Subtraction Angiography,DSA)的后交通動(dòng)脈起始部膨大(posterior communicating artery infundibular dilatation,Pcom-ID)發(fā)病率,描述Pcom-ID患者的臨床特征,分析Pcom-ID形成的危險(xiǎn)因素,探討顱腦計(jì)算機(jī)斷層掃描血管造影(Computed Tomography Angiography,CTA)對Pcom-ID的診斷價(jià)值及提高診斷正確率的方法,回顧特殊病例,總結(jié)Pcom-ID患者的預(yù)后及轉(zhuǎn)歸,以增強(qiáng)對Pcom-ID的認(rèn)識,為臨床的診斷及治療提供理論支持。方法收集2014年1月-2016年1月于浙江大學(xué)附屬第一醫(yī)院神經(jīng)外科行顱腦DSA患者的臨床資料,根據(jù)納入標(biāo)準(zhǔn)與排除標(biāo)準(zhǔn),獲得發(fā)病率；通過與正常組的比較,獲得發(fā)病危險(xiǎn)因素；以顱腦DSA為金標(biāo)準(zhǔn),評估顱腦CTA的診斷正確率,并更改方法,驗(yàn)證其有效性；回顧分析特殊病例,總結(jié)病例特點(diǎn)、預(yù)后及轉(zhuǎn)歸。結(jié)果本研究共納入857例行顱腦DSA造影患者,發(fā)現(xiàn)Pcom-ID患者51例,發(fā)病率為5.9%。在Pcom-ID患者中,男性占31.37%,女性占68.63%；平均年齡54歲,集中分布在40-70歲之間；‘27.45%有吸煙史,,17.65%有飲酒史；43.14%有高血壓史；3.92%有糖尿病史；54.90%合并動(dòng)脈瘤,其中25.49%為對側(cè)后交通動(dòng)脈瘤；64.71%位置處于顱腦左側(cè),27.45%位于右側(cè),7.84%為雙側(cè)；Pcom-ID發(fā)展為動(dòng)脈瘤患者2例,疑似Pcom-ID破裂1例；Pcom-ID更傾向發(fā)生于年齡偏大的女性患者,高血壓為Pcom-ID發(fā)生的危險(xiǎn)因素；顱腦CTA對Pcom-ID的診斷正確率為21.21%,方法改良后的診斷正確率為36.36%。結(jié)論本中心基于DSA的Pcom-ID發(fā)病率為5.9%,好發(fā)于40-70歲,多伴有動(dòng)脈瘤,女性、年齡及高血壓為Pcom-ID的危險(xiǎn)因素,顱腦CTA對Pcom-ID的診斷及隨訪價(jià)值不大,但通過改變CTA的窗寬、窗位,調(diào)整觀察角度,結(jié)合Pcom-ID的形態(tài)學(xué)特征,可以提高顱腦CTA對Pcom-ID的診斷正確率,另外,Pcom-ID可以直接發(fā)生破裂,也可在膨大壁上長出水泡樣結(jié)構(gòu),水泡樣結(jié)構(gòu)可以發(fā)生破裂,膨大亦會(huì)演變?yōu)閯?dòng)脈瘤,發(fā)生破裂。
[Abstract]:Objective to obtain the incidence of posterior communicating artery infundibular dilatation Pcom-IDD in neurosurgery department of the first affiliated Hospital of Zhejiang University based on digital subtraction angiography (DSA) of posterior communicating artery, to describe the clinical characteristics of Pcom-ID patients and to analyze the risk factors of Pcom-ID formation. To explore the diagnostic value of computed Tomography angiography (CTA) for Pcom-ID and to improve the diagnostic accuracy of Pcom-ID, to review the special cases and to summarize the prognosis and outcome of Pcom-ID patients, so as to enhance the understanding of Pcom-ID. Methods the clinical data of patients with craniocerebral DSA were collected from January 2014 to January 2016 in the first affiliated Hospital of Zhejiang University. Compared with the normal group, the risk factors were obtained, the diagnostic accuracy of craniocerebral CTA was evaluated with DSA as the gold standard, and the method was changed to verify its validity, and the special cases were analyzed retrospectively, and the characteristics of the cases were summarized. Results in this study, we included 857 patients with craniocerebral DSA angiography. 51 cases of Pcom-ID were found, the incidence rate was 5.90.There were 31.37 males and 68.63 females in Pcom-ID patients, with an average age of 54 years. 27.45% of patients aged 40 to 70 years old had a history of smoking and 17.65% had a history of drinking alcohol. 43.14% had a history of hypertension and 3.92% had a history of diabetes mellitus (54.90%) with aneurysms. 25.49% of the aneurysms were located on the left side of the brain in 64.71% of the patients. 7.84% of the patients were in the right side of the brain. 2 patients with bilateral Pcom-ID developed into aneurysms. One case of suspected rupture of Pcom-ID was more likely to occur in older female patients. Hypertension was the risk factor of Pcom-ID, the correct rate of diagnosis of Pcom-ID by craniocerebral CTA was 21.21, and the correct rate of improved method was 36.36.Conclusion the incidence rate of Pcom-ID based on DSA in this center is 5.9%, which usually occurs between 40 and 70 years old, most of them are accompanied by aneurysms. Age and hypertension were the risk factors of Pcom-ID. Craniocerebral CTA was of little value in the diagnosis and follow-up of Pcom-ID. However, by changing the window width and window position of CTA, adjusting the observation angle and combining with the morphological characteristics of Pcom-ID, the diagnostic accuracy of CTA in Pcom-ID could be improved. In addition, Pcom-ID can rupture directly, blister-like structure can also grow on the expanded wall, blister-like structure can be ruptured and dilated into aneurysm, ruptured.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R743

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