本文關(guān)鍵詞： 腸系膜上動(dòng)脈 夾層 夾角 機(jī)制　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景和目的自發(fā)性孤立性腸系膜上動(dòng)脈夾層(spontaneous isolated dissection of the superior mesenteric artery,SIDSMA)曾經(jīng)被認(rèn)為是罕見的疾病,本病在1947年被Bauersfeld首次報(bào)道,隨著多排螺旋CT血管成像(Multi-slice spiral computed tomography angiography,MSCTA)的應(yīng)用普及,越來越多的自發(fā)性孤立性腸系膜上動(dòng)脈夾層被診斷出來,包括一些沒有癥狀的腸系膜上動(dòng)脈夾層。本病的病因及發(fā)病機(jī)制尚不明確,以往大部分文獻(xiàn)報(bào)道多側(cè)重于本病的診斷與治療策略、效果,而對(duì)于本病的發(fā)病病因與發(fā)病機(jī)制并沒有進(jìn)行深入探討。血流動(dòng)力學(xué)的改變?cè)谥鲃?dòng)脈夾層形成過程中起重要作用這一觀點(diǎn)普遍被人們所接受,依據(jù)此點(diǎn),我們嘗試分析血流動(dòng)力學(xué)改變與自發(fā)性孤立性腸系膜上動(dòng)脈夾層的關(guān)系,而影響腸系膜上動(dòng)脈內(nèi)血流狀態(tài)的主要因素是腹主動(dòng)脈(abdominal aorta,AA)與腸系膜上動(dòng)脈(superior mesenteric artery,SMA)之間的夾角,因此有必要對(duì)腸系膜上動(dòng)脈夾角與自發(fā)性孤立性腸系膜上動(dòng)脈夾層之間關(guān)系進(jìn)行相關(guān)探討。資料與方法回顧性分析2014年5月至2017年2月鄭州大學(xué)第一附屬醫(yī)院腔內(nèi)血管外科收治的35例SIDSMA患者的臨床資料。其中男性33例,女性2例,年齡39-84歲,平均51歲,所有患者均經(jīng)64排MSCTA明確診斷,并測(cè)量SMA夾角大小;收集35例正常成年人SMA夾角,比較SIDSMA患者與正常成年人的SMA夾角差別;測(cè)量SIDSMA破口位置至SMA開口處距離,對(duì)比其與SMA夾角的關(guān)系,并對(duì)結(jié)果進(jìn)行探討、分析。結(jié)果SIDSMA患者的SMA夾角大于正常成年人的SMA夾角(68.2±12.6°,55.8±17.8°,P0.05),差別有統(tǒng)計(jì)學(xué)意義,t=3.387,95%置信區(qū)間(5.129,19.850);SMA夾角與SIDSMA患病的OR值為1.054,95%置信區(qū)間(1.018,1.091)。SMA夾角在50°~80°之間時(shí)SIDSMA發(fā)病人數(shù)占總體的80%,其中60°~70°是所有組距段內(nèi)發(fā)病人數(shù)最多的角度范圍,占31.4%。在60°~70°之間時(shí)破口位置集中在20-30mm之間,而此區(qū)域是SMA移行區(qū)所在部位。結(jié)論SMA夾角與SIDSMA的發(fā)病有一定的相關(guān)性,SMA夾角在60°~70°時(shí)SIDSMA發(fā)病率可能更高;SIDSMA的發(fā)病可能受SMA夾角和SMA移行區(qū)的特殊解剖結(jié)構(gòu)共同影響。
[Abstract]:Background and objective spontaneous isolated dissection of the superior mesenteric artery SIDSMA was once considered to be a rare disease, which was first reported by Bauersfeld in 1947. A growing number of spontaneous isolated superior mesenteric artery dissections, including asymptomatic superior mesenteric artery dissections, have been diagnosed. Most of the previous literature reports focused on the diagnosis and treatment of the disease, the results, However, the etiology and pathogenesis of the disease have not been thoroughly discussed. The idea that hemodynamic changes play an important role in the formation of aortic dissection is generally accepted. We tried to analyze the relationship between hemodynamic changes and spontaneous superior mesenteric artery dissection. The main factor affecting the blood flow status in superior mesenteric artery was the angle between abdominal aorta and superior mesenteric artery superior mesenteric artery (SAA) and superior mesenteric artery (SMA). Therefore, it is necessary to explore the relationship between the angle of superior mesenteric artery and spontaneous isolated superior mesenteric artery dissection. Data and methods retrospective analysis of the first affiliated hospital of Zhengzhou University from May 2014 to February 2017. Clinical data of 35 patients with SIDSMA treated by internal vascular surgery. Two female patients (39-84 years old, mean 51 years old) were diagnosed by 64 rows of MSCTA and the angle of SMA was measured, and 35 cases of normal adults were collected to compare the SMA angle between SIDSMA patients and normal adults. The distance between SIDSMA break position and SMA opening was measured, and the relation between SMA and SMA was compared, and the results were discussed. Results the SMA angle of SIDSMA patients was higher than that of normal adults (68.2 鹵12.6 擄/ 55.8 鹵17.8 擄/ p 0.05). The difference was statistically significant (P < 0.05). The difference between the SMA angle of SIDSMA patients and the incidence of SIDSMA was 1.05495% confidence interval 1.018181.091% and the incidence of SIDSMA was between 50 擄and 80 擄. 80, of which 60 擄to 70 擄was the angle range of the highest number of cases in all groups. Between 60 擄and 70 擄, the opening position is concentrated in the range of 20-30 mm, Conclusion there is a certain correlation between the SMA angle and the incidence of SIDSMA. The incidence of SIDSMA may be higher when the angle of SIDSMA is 60 擄to 70 擄. The incidence of SIDSMA may be affected by the SMA angle and the special anatomical structure of SMA transition area.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.2

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