本文關(guān)鍵詞： 主動脈弓 變異 解剖 測量 體層攝影術(shù) CTA　出處：《天津醫(yī)科大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的本研究通過多層螺旋CT血管成像對人體在體主動脈弓凸側(cè)分支血管進(jìn)行分析,觀察主動脈弓分支的相關(guān)變異,標(biāo)準(zhǔn)型主動脈弓的三個分支血管即頭臂干動脈、左頸總動脈及左鎖骨下動脈在主動脈弓的分支位置,并對標(biāo)準(zhǔn)型主動脈弓的三個分支進(jìn)行相關(guān)解剖學(xué)定量測量,旨在為臨床工作提供幫助。 資料及方法按照入組標(biāo)準(zhǔn)搜集2009年～2010年的237例頸部多層螺旋CT血管成像圖,采用多種圖像后處理技術(shù),獲得主動脈弓部重組圖像進(jìn)行研究。對所有病例進(jìn)行容積再現(xiàn)和多平面容積重建(MPR),多角度、多平面、多方位立體觀察主動脈弓及其主要分支的解剖結(jié)構(gòu)。 對其中211例標(biāo)準(zhǔn)型主動脈弓的病例,記錄頭臂干動脈、左頸總動脈及左鎖骨下動脈在主動脈弓的分支位置。 以原始軸位圖像為基礎(chǔ),分別確定可顯示頭臂干動脈與左頸總動脈及左頸總動脈與左鎖骨下動脈間距的MPR斜位圖像平面與矢狀面的夾角,分別做斜位MPR容積重組圖像,并以此斜位MPR圖像為基礎(chǔ)觀察容積再現(xiàn)圖像,在最佳觀測平面上分別測量頭臂干動脈與左頸總動脈和左頸總動脈與左鎖骨下動脈的間距,并讀出頭臂干動脈、左頸總動脈、左鎖骨下動脈在分支處的直徑。使用SPSS17.0軟件分析所得標(biāo)準(zhǔn)型主動脈弓的頭臂干動脈與左頸總動脈和左頸總動脈與左鎖骨下動脈的間距、主動脈弓各分支在分支處的直徑,對是否存在年齡及性別差異進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果①主動脈弓分為兩種類型,標(biāo)準(zhǔn)型和變異型,其中標(biāo)準(zhǔn)型最常見,占總病例數(shù)的89.03%,變異型為總病例數(shù)的10.97%。②變異型中可見四種不同類型的變異。左側(cè)椎動脈自主動脈弓發(fā)出并位于左頸總動脈和左鎖骨下動脈之間者13例,為變異型患者的50%,為總病例數(shù)的5.49%；左頸總動脈自頭臂干發(fā)出者10例,為變異型的38.46%,為總病例數(shù)的4.22%；左頸總動脈發(fā)自于頭臂干并存左椎動脈發(fā)自主動脈弓并位于左頸總動脈和左鎖骨下動脈之間者2例,為變異型的7.69%,為總病例數(shù)的0.84%；右位主動脈弓伴迷走左鎖骨下者1例,為變異型的3.85%,為總病例數(shù)的0.42%。③標(biāo)準(zhǔn)型主動脈弓的三分支血管中,頭臂干動脈在主動脈弓的開口位置位于主動脈弓后上壁者為87.67%,位于主動脈弓正上壁者為9.48%,位于主動脈弓前上壁者為2.84%；左頸總動脈在主動脈弓的分支開口位置位于主動脈弓后上壁者為7.58%,位于主動脈弓正上壁者為36.97%,位于主動脈弓前上壁者為55.45%；左鎖骨下動脈在主動脈弓的分支開口位置位于主動脈弓后上壁者為27.49%,位于主動脈弓正上壁者為60.19%,位于主動脈弓前上壁者為12.32%；④標(biāo)準(zhǔn)型主動脈弓的三個分支血管中,顯示頭臂干動脈和左頸總動脈間距的平面與矢狀面之間的夾角最大值為120.7°,最小值為14.6°,平均角度為71.47°±2.16°,無年齡及性別差異；顯示左頸總動脈和左鎖骨下動脈間距的平面與矢狀面之間的夾角最大值為96.6°,最小值為3.6°,平均角度為30.82°±1.62°,無年齡及性別差異。⑤頭臂干動脈與左頸總動脈的間距最大值為19.60mm,最小值為0.80mm,平均值為5.59±0.48mm,無年齡及性別差異；左頸總動脈與左鎖骨下動脈最大距離最大值為24.20mm,最小值為0.80mm,平均值為8.76±0.63mm,無年齡及性別差異。⑥頭臂干動脈在主動脈弓分支處直徑的最大值為19.70mm,最小值為8.10mm,平均值為12.74±0.35mm,無年齡及性別差異；左頸總動脈在主動脈弓分支處的直徑最大值為18.0mm,最小值為3.30mm,平均值為8.37±0.29mm,無年齡及性別差異；左鎖骨下動脈在主動脈弓分支處的直徑最大值為17.00mm,最小值為4.30mm,平均值為10.07±0.31mm,無年齡差異,存在性別差異,女性較男性細(xì)。 結(jié)論：①主動脈弓分支分型為標(biāo)準(zhǔn)型和變異型,其中標(biāo)準(zhǔn)型為總病例數(shù)89.03%,變異型為總病例數(shù)的10.97%,與既往國內(nèi)外文獻(xiàn)報(bào)道相同。②變異型中可分為四種不同類型,各分型所占總病例數(shù)的百分比與既往國內(nèi)外報(bào)道的數(shù)據(jù)相符合。但是,四種變異類型中,左側(cè)椎動脈自主動脈弓發(fā)出并位于左頸總動脈和左鎖骨下動脈之間者最多,與既往國內(nèi)外報(bào)道的數(shù)據(jù)不同。③標(biāo)準(zhǔn)型主動脈弓三個分支中,頭臂干動脈的分支開口位置多位于主動脈弓的后上壁,左頸總動脈的分支開口位置多位于主動脈弓的前上壁,左鎖骨下動脈的開口位置多位于主動脈弓的正上壁。④標(biāo)準(zhǔn)型主動脈弓顯示頭臂干動脈和左頸總動脈間距的平面與矢狀面之間的夾角,最大值為120.7°,最小值為14.6°,平均角度為71.47°±2.16°,無年齡及性別差異；顯示左頸總動脈和左鎖骨下動脈間距的平面與矢狀面之間的夾角,最大值為96.6°,最小值為3.6°,平均角度為30.82°±1.62°,無年齡及性別差異。在選擇性造影中,觀察頭臂干動脈的最佳角度為右前斜位71°,而并不是常規(guī)的攝影位置即左前斜位30°。⑤頭臂干動脈與左頸總動脈的間距最大值為19.60mm,最小值為0.80mm,平均值為5.59±0.48mm,無年齡及性別差異；左頸總動脈與左鎖骨下動脈的間距的最大值為24.20mm,最小值為0.80mm,平均值為8.76±0.63mm,無年齡及性別差異。頭臂干動脈與左頸總動脈的平均間距比左頸總動脈與左鎖骨下動脈的平均間距小。⑥頭臂干動脈在分支處的直徑最大值為19.70mm,最小值為8.10mm,平均值為12.74±0.35mm,最粗,無年齡及性別差異；左頸總動脈在分支處的直徑最大值為18.0mm,最小值為3.30mm,平均值為8.37±0.29mm,最細(xì),無年齡及性別差異；左鎖骨下動脈在分支處的直徑最大值為17.00mm,最小值為4.30mm,平均值為10.07±0.31mm,無年齡差異,存在性別差異,女性較男性細(xì)。在臨床工作中選擇血管支架時(shí),在考慮多方面因素后,可根據(jù)不同的測量結(jié)果選擇不同型號的血管支架,以取得最佳效果。
[Abstract]:The purpose of this study by multi-slice spiral CT angiography in the human body in the convex side of the aortic arch branch vessel analysis, correlation observation of aortic arch branch, three branch vessel standard of the aortic arch is brachiocephalic artery and branch position left common carotid artery and left subclavian artery in aortic arch, and three a branch of the standard type of aortic arch were anatomic quantitative measurement, in order to provide help for the clinical work.
Materials and methods according to the inclusion criteria collect 237 cases with neck multislice CT angiography picture from 2009 to 2010, using a variety of image postprocessing techniques, to obtain the aortic arch reconstruction images were studied. By volume rendering and multi planar volume reconstruction in all cases (MPR), multi angle, multi planar, three-dimensional anatomical structure observation of the aortic arch and its main branches.
The branches of the head arm, the left common carotid artery and the left subclavian artery were located in the branches of the aortic arch in 211 cases of the standard aortic arch.
The original axial images, can be displayed respectively to determine the brachiocephalic artery and left common carotid artery and left common carotid artery and left subclavian artery between MPR image plane and oblique sagittal angle respectively, oblique MPR VR, and the oblique MPR images based on the observation volume reconstructed images were measured, brachiocephalic artery spacing and left carotid artery and left common carotid artery and left subclavian artery in the best observation plane, and read head arm artery, left common carotid artery, the diameter of the left subclavian artery at the branch of the head and arm. Analysis of the standard type SPSS17.0 aortic arch the spacing between the artery and the software stem left common carotid artery and left common carotid artery and left subclavian artery, the aortic arch branches at the branch diameter, whether there is age and gender differences were statistically analyzed.
The aortic arch can be divided into two types, standard and variant, one of the most common standard, the total number of cases of 89.03%, the 10.97%. variant is the total number of cases of variant visible in four different types of variation. The left vertebral artery and 13 cases from independent arterial arch is located between the left carotid the artery and the left subclavian artery, for patients with variant 50%, the total number of cases was 5.49%; the left common carotid artery from the brachiocephalic trunk in 10 cases a variant, as of 38.46%, the total number of cases was 4.22%; 2 cases of left common carotid artery from the brachiocephalic trunk both left vertebral artery hair independent arterial arch and is located between the left carotid artery and left subclavian artery, as a variant of the 7.69%, the total number of cases was 0.84%; right aortic arch with aberrant left clavicle were 1 cases, for 3.85% variants, three branch blood 0.42%. standard type aortic arch for the total number of cases. Tube, head Arm trunk artery in the open position of the aortic arch in the aortic arch after the wall is 87.67%, located in the aortic arch is on the wall for 9.48%, located in the anterior wall of aortic arch was 2.84%; branches of the left common carotid artery in aortic arch openings located in the aortic arch after the wall is 7.58%, is located in the aortic arch on the wall is 36.97%, located on the front wall of aortic arch was 55.45%; the branch of left subclavian artery in aortic arch openings located in the aortic arch after the wall is 27.49%, located in the aortic arch is on the wall for 60.19%, located in the anterior wall of aortic arch was 12.32%; three branches of the standard type vessels aortic arch, display brachiocephalic trunk between the maximum angle plane and sagittal artery and left common carotid artery spacing is 120.7 degrees, the minimum value is 14.6 degrees, the average angle is 71.47 degrees - 2.16 degrees, no age and gender differences; left neck The maximum angle between the plane and the sagittal plane spacing of the artery and the left subclavian artery is 96.6 degrees, the minimum value is 3.6 degrees, the average angle is 30.82 degrees - 1.62 degrees, no age and gender differences. The maximum distance between the brachiocephalic artery and left common carotid artery was 19.60mm, the minimum value is 0.80mm, the average value is 5.59 + 0.48mm, no age and gender differences; the left carotid artery and left subclavian artery maximum distance of maximum value is 24.20mm, the minimum value is 0.80mm, the average value is 8.76 + 0.63mm, no age and gender differences. The brachiocephalic artery diameter of the aortic arch branch maximum. 19.70mm, the minimum value is 8.10mm, the average value is 12.74 + 0.35mm, no age and gender differences; the left common carotid artery in aortic arch branch diameter at the maximum value is 18.0mm, the minimum value is 3.30mm, the average value is 8.37 + 0.29mm, no age and gender differences; the left subclavian artery in aortic The maximum diameter of the arch branch is 17.00mm, the minimum value is 4.30mm, the average value is 10.07 + 0.31mm, there is no difference of age, there is sex difference, and the female is thinner than the male.
Conclusion: the aortic arch branch divided into standard and variant, the standard for the total number of cases 89.03%, 10.97% variants for the total number of cases, with previously reported in the literature. The same mutation type can be divided into four different types, with the total number of cases reported for each type% than with the previous domestic and foreign data. However, four types of variation in the left vertebral artery and arterial arch is located between the independent from the left carotid artery and left subclavian artery were the most, unlike previous reports at home and abroad. The standard data type three aortic arch branch, brachiocephalic trunk the arterial branch opening position located in the aortic arch on the wall, the wall branch of the left common carotid artery opening position located in the aortic arch, is on the wall opening position of the left subclavian artery in aortic arch. The standard arch anonyma dynamic display The angle between the plane and the sagittal vein and left carotid artery spacing, the maximum value is 120.7 degrees, the minimum value is 14.6 degrees, the average angle is 71.47 degrees - 2.16 degrees, no age and gender differences; that the angle between the plane and the sagittal plane of left carotid artery and left subclavian artery in the distance and the maximum value is 96.6 degrees, the minimum value is 3.6 degrees, the average angle is 30.82 degrees - 1.62 degrees, no age and gender differences. In selective angiography, the best observation angle of brachiocephalic arteries to right anterior oblique 71 degrees, rather than the conventional camera position is left anterior oblique 30 degrees. Maximum distance between the brachiocephalic artery and left common carotid artery was 19.60mm, the minimum value is 0.80mm, the average value is 5.59 + 0.48mm, no age and gender differences; the left carotid artery and left subclavian artery, the maximum spacing is 24.20mm, the minimum value is 0.80mm, the average value was 8.76 + 0.63mm. No age and gender differences in the head and arm. The average distance between stem artery and left common carotid artery than the average spacing between the left carotid artery and left subclavian artery. The brachiocephalic arteries at the branch of the largest diameter value is 19.70mm, the minimum value is 8.10mm, the average value is 12.74 + 0.35mm, the most thick, no age and gender differences; the left carotid the diameter of the artery at the branch of the maximum value was 18.0mm and the minimum was 3.30mm, the average value is 8.37 + 0.29mm, the fine, no age and gender differences; the left subclavian artery at the branch of the maximum diameter of 17.00mm, the minimum value is 4.30mm, the average value is 10.07 + 0.31mm, there is no age difference. Gender differences in women than in men. The stent in clinical choice of fine work, in consideration of many factors, according to different measurement results to choose different types of stents, to achieve the best results.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R322.121;R816.2

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