發(fā)布時(shí)間：2018-06-21 06:39

  本文選題：大腦前動(dòng)脈 + Al優(yōu)勢(shì)征�。� 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的：探討大腦前動(dòng)脈A1-A2段夾角與前交通動(dòng)脈(anterior communicating artery, ACoA)動(dòng)脈瘤的發(fā)生與破裂的關(guān)系。 方法：回顧性分析64例前交通動(dòng)脈瘤及隨機(jī)選取的同期188例非前交通動(dòng)脈瘤的影像學(xué)資料；利用MSCTA夾角測(cè)量工具測(cè)量A1-A2段夾角(外側(cè)夾角),記錄并比較前交通動(dòng)脈瘤與非前交通動(dòng)脈瘤、前交通動(dòng)脈瘤破裂組與非破裂組之間A1-A2夾角及角度差；A1段形態(tài)上分為A1段優(yōu)勢(shì)型(A1優(yōu)勢(shì)征),A1均衡型；動(dòng)脈瘤依瘤體指向分為前上型、前下型、后上型、后下型及復(fù)雜型；動(dòng)脈瘤依瘤體在前交通復(fù)合體(anterior communicating artery complexus,ACoAC)位置分左偏型、右偏型、中央型。 結(jié)果：①A1段形態(tài)：前交通動(dòng)脈瘤組,A1段優(yōu)勢(shì)型36例(56.3%),左側(cè)A1段優(yōu)勢(shì)型28例(43.8%),右側(cè)A1段優(yōu)勢(shì)型8例(12.5%)非前交通動(dòng)脈瘤組,A1段優(yōu)勢(shì)型60例(31.9%),左側(cè)A1段優(yōu)勢(shì)型39例(20.7%),右側(cè)A1優(yōu)勢(shì)型21例(11.2%)。前交通動(dòng)脈瘤組較非前交通動(dòng)脈瘤組A1段優(yōu)勢(shì)發(fā)生率高(x2=11.99,P=0.001),左側(cè)A1段優(yōu)勢(shì)發(fā)生率高(x2=12.95,P＝0.001),右側(cè)A1段優(yōu)勢(shì)發(fā)生率相當(dāng)(x2=0.083,P=0.821)；②A1優(yōu)勢(shì)發(fā)生情況：左側(cè)A1優(yōu)勢(shì)共67例(26.6%),右側(cè)A1優(yōu)勢(shì)共29例(11.5%),左側(cè)A1優(yōu)勢(shì)較右側(cè)A1優(yōu)勢(shì)發(fā)生率高(x2=11.87,P=0.000)；③前交通動(dòng)脈瘤指向：前上型28例,前下型28例,后上型5例,后下型3例,復(fù)雜型0例；④A1-A2夾角及角度差：A1均衡型：前交通動(dòng)脈瘤組,左偏型13例,平均夾角(94.4±15.4)°；右偏型8例,平均夾角(95.9±13.1)°；中央型7例,兩側(cè)平均夾角(102.1±26.0)°；21例非中央型前交通動(dòng)脈瘤平均角度差(22.4±15.8)°；非前交通動(dòng)脈瘤組,共128例,左側(cè)夾角(123.9±18.8)°,右側(cè)夾角(121.6±18.7)°,平均夾角(122.7±18.4)°,平均角度差(5.8±4.3)°；A1均衡型中,前交通動(dòng)脈瘤組較非前交通動(dòng)脈瘤組瘤側(cè)A1-A2夾角變小(t=-5.450, P=0.000; t=-3.838, P=0.000),角度差變大(t＝9.954,P=0.000),即使是中央型前交通動(dòng)脈瘤也較非前交通動(dòng)脈瘤組A1-A2夾角小(t=-2.820,P=0.006)；A1優(yōu)勢(shì)型：前交通動(dòng)脈瘤組,共36例,平均夾角(98.8±18.0)°；左側(cè)優(yōu)勢(shì)28例,平均夾角(100.5±17.9)°；右側(cè)優(yōu)勢(shì)8例,平均夾角(93.0±18.4)°；非前交通動(dòng)脈瘤組,共60例,平均夾角(118.8±19.1)°；左側(cè)優(yōu)勢(shì)39例,平均夾角(122.5±19.3)°；右側(cè)優(yōu)勢(shì)21例,平均夾角(111.8±17.0)°；A1優(yōu)勢(shì)型中,不論總體還是左側(cè)優(yōu)勢(shì)或右側(cè)優(yōu)勢(shì),,前交通動(dòng)脈瘤組較非前交通動(dòng)脈瘤組瘤側(cè)A1-A2夾角變小(t=-5.077, P=0.000; t=-4.769, P=0.000; t=-2.602,P=0.015)；⑤A1-A2夾角及角度差：A1均衡型：破裂組,左偏型6例,平均夾角(99.3±10.1)°；右偏型6例,平均夾角(93.4±14.5)°；中央型6例,兩側(cè)平均夾角(106.2±25.9)°；12例非中央型前交通動(dòng)脈瘤破裂型平均角度差(22.1±16.8)°；非破裂組,左偏型6例,平均夾角(96.8±17.8)°；右偏型3例,平均夾角(105.9±4.4)°；中央型1例,兩側(cè)平均夾角77.5°；9例非中央型前交通動(dòng)脈瘤平均角度差(20.1±19.0)°；A1均衡型前交通動(dòng)脈瘤中,破裂組較非破裂組瘤側(cè)A1-A2夾角及角度差均無(wú)明顯變化(P0.05)；A1優(yōu)勢(shì)型前交通動(dòng)脈瘤,破裂組,共23例,平均夾角(101.2±18.5)°；左側(cè)優(yōu)勢(shì)18例,平均夾角(102.1±18.4)°；右側(cè)優(yōu)勢(shì)5例,平均夾角(97.8±20.8)°；非破裂組,共13例,平均夾角(94.6±16.9)°；左側(cè)優(yōu)勢(shì)10例,平均夾角(97.5±17.5)°；右側(cè)優(yōu)勢(shì)3例,平均夾角(85.1±13.1)°；A1優(yōu)勢(shì)型前交通動(dòng)脈瘤中,不論總體還是左側(cè)優(yōu)勢(shì)或右側(cè)優(yōu)勢(shì),破裂組較非破裂組A1-A2夾角均無(wú)明顯變化(P0.05)。 結(jié)論：前交通動(dòng)脈瘤的發(fā)生與大腦前動(dòng)脈A1段優(yōu)勢(shì)有關(guān),且具有A1優(yōu)勢(shì)征者前交通動(dòng)脈瘤的發(fā)生率明顯增高；A1優(yōu)勢(shì)征左側(cè)較右側(cè)發(fā)生率高；大腦前動(dòng)脈A1-A2夾角及角度差可協(xié)助預(yù)測(cè)前交通動(dòng)脈瘤的發(fā)生,且較小的A1-A2夾角與較大的角度差更容易發(fā)生前交通動(dòng)脈瘤,但無(wú)法評(píng)估前交通動(dòng)脈瘤的破裂出血。
[Abstract]:Objective: To investigate the relationship between the angle of A1-A2 segment of anterior cerebral artery and the occurrence and rupture of anterior communicating artery (ACoA) aneurysms.
Methods: the imaging data of 64 anterior communicating artery aneurysms and 188 non anterior communicating aneurysms were retrospectively analyzed. The angle of A1-A2 segment (lateral angle) was measured by MSCTA angle measuring tool, and the anterior communicating artery aneurysm and non anterior communicating artery aneurysm, the A1-A2 clip between the anterior communicating artery aneurysm rupture group and the non rupture group were recorded and compared. Angle and angle difference; A1 segment is divided into A1 segment dominant (A1 dominance) and A1 equilibrium; aneurysms are divided into anterior, anterior, posterior, posterior, posterior and complex, and aneurysm in the anterior communicating complex (anterior communicating artery Complexus, ACoAC), left partial, right deviation, central type.
Results: A1 segment morphology: anterior communicating artery aneurysm group, A1 segment dominant type 36 cases (56.3%), left A1 segment dominant 28 cases (43.8%), right A1 segment dominant 8 cases (12.5%) non anterior communicating artery aneurysm group, A1 segment dominant 60 cases (31.9%), left A1 segment dominant 39 cases (20.7%), and right A1 dominant 21 cases (11.2%). Anterior communicating artery aneurysm group was more than non anterior communicating artery aneurysm. The dominant incidence of A1 segment was high (x2=11.99, P=0.001), and the incidence of left A1 segment was high (x2=12.95, P = 0.001), and the incidence of the right A1 segment was equal (x2=0.083, P=0.821), and the occurrence of A1 superiority was 67 cases (26.6%) on the left A1 superiority and 29 cases (11.5%) with the right A1 superiority. (3) anterior communicating artery aneurysm point: 28 cases of anterior upper type, 28 cases of anterior and lower type, 5 cases of posterior upper type, 3 cases of posterior inferior type and 0 case of complex type; (4) A1-A2 angle and angle difference: A1 equilibrium type: anterior communicating artery aneurysm group, left deviation 13 cases, average angle (94.4 + 15.4) degree, right deviation 8 cases, average angle of angle (95.9 + 13.1), average angle of central type, 102.1 + 26. (102.1 + 26.) 0); 21 cases of non central anterior communicating artery aneurysm average angle difference (22.4 + 15.8); non anterior communicating artery aneurysm group, 128 cases, left angle (123.9 + 18.8) degrees, right angle (121.6 + 18.7) degrees, average angle (122.7 + 18.4) degrees, average angle difference (5.8 + 4.3) degrees, A1 equilibrium, anterior communicating artery aneurysm group is more than non anterior communicating aneurysm group tumor side A1-A2 The angle became smaller (t=-5.450, P=0.000; t=-3.838, P=0.000), and the angle difference was larger (t = 9.954, P=0.000). Even the central anterior communicating artery aneurysm was smaller than the non anterior communicating artery group (t=-2.820, P=0.006); A1 dominant type: anterior communicating artery aneurysm group, 36 cases, the average angle (98.8 + 18), 28 cases with the left advantage, and the average angle of 100.5 +. 17.9); 8 cases on the right side, average angle (93 + 18.4); non anterior communicating artery aneurysm group, 60 cases, average angle (118.8 + 19.1) degrees, left advantage 39 cases, average angle (122.5 + 19.3) degree, right dominance 21, average angle (111.8 + 17) degrees; A1 dominance, no matter overall or left superiority or right side superiority, anterior communicating artery aneurysm group The A1-A2 angle of the tumor side of the aneurysm group was smaller (t=-5.077, P=0.000; t=-4.769, P=0.000; t=-2.602, P=0.015); (5) A1-A2 angle and angle difference: A1 equilibrium type: rupture group, left partial type 6 cases, average angle (99.3 + 10.1) degree; right deviation 6 cases, average angle (93.4 + 14.5) degrees; central type 6 cases, average angle of both sides (106.2 + 25.9) degrees; 1 The average angle difference between 2 cases of non central anterior communicating artery aneurysm was (22.1 + 16.8) degrees, the non rupture group, the left partial type 6 cases, the mean angle (96.8 + 17.8) degrees, the right partial type 3 cases, the average angle (105.9 + 4.4) degrees, the 1 central type and the average angle 77.5 degrees in the two sides; the average angle difference of the non central anterior communicating artery aneurysm (20.1 +) degrees in 9 cases, and the A1 balance type forward. In the aneurysm, there was no obvious change in the A1-A2 angle and angle difference between the ruptured group and the non rupture group (P0.05); the A1 predominant anterior communicating artery aneurysm and the rupture group were 23 cases, the average angle (101.2 + 18.5) degrees, the left advantage 18 cases, the mean angle (102.1 + 18.4) degrees, the right right potential 5 cases, the average angle (97.8 + 20.8) degrees, and the non rupture group, 13 cases, mean, average 13 cases, mean average. The angle (94.6 + 16.9); the left advantage 10 cases, the average angle (97.5 + 17.5) degrees, the right advantage 3 cases, the average angle (85.1 + 13.1) degrees, A1 predominant anterior communicating artery aneurysm, no matter overall or left superiority or right side superiority, there was no significant change in the angle of A1-A2 in the rupture group compared with the non rupture group (P0.05).
Conclusion: the occurrence of anterior communicating artery aneurysm is related to the predominant A1 segment of the anterior cerebral artery, and the incidence of anterior communicating artery aneurysm with A1 dominance is significantly higher; the incidence of the left side of the A1 advantage sign is higher than that on the right side. The angle and angle difference of the anterior cerebral artery can help to predict the occurrence of the anterior communicating aneurysm, and the smaller A1-A2 angle and the larger angle are larger. Angle difference is more likely to occur in anterior communicating artery aneurysms, but it can not evaluate the rupture and bleeding of anterior communicating artery aneurysms.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R651.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 袁亮;鄒利光;李玉偉;;前交通動(dòng)脈瘤與大腦前動(dòng)脈A1段缺如相關(guān)性研究[J];放射學(xué)實(shí)踐;2010年06期

2 袁亮;李玉偉;;大腦前動(dòng)脈發(fā)育變異與前交通動(dòng)脈瘤相關(guān)性研究進(jìn)展[J];國(guó)際醫(yī)學(xué)放射學(xué)雜志;2009年02期

3 高鵬;陳左權(quán);顧斌賢;潘慶剛;鄧東風(fēng);凌鋒;;大腦前動(dòng)脈A1段優(yōu)勢(shì)和前交通動(dòng)脈瘤相關(guān)性研究[J];同濟(jì)大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2007年04期

，

本文編號(hào)：2047618