【摘要】：目的：測(cè)量觀察術(shù)前、術(shù)后主動(dòng)脈不同平面真假腔幾何參數(shù),結(jié)合患者隨訪生存情況,使用錐型支架行腔內(nèi)修復(fù)術(shù)(TEVAR)治療慢性主動(dòng)脈B型夾層的有效性,探討術(shù)后主動(dòng)脈形態(tài)學(xué)重塑的過程。材料與方法：納入云南省昆明醫(yī)科大學(xué)附屬第一醫(yī)院自2012年1月至2015年1月使用錐形支架行TEVAR術(shù)治療的27例慢性Stanford B型主動(dòng)脈夾層病人的CTA掃描圖像后,選取主動(dòng)脈峽部、降主動(dòng)脈中端、降主動(dòng)脈遠(yuǎn)端、腹腔干水平、腎動(dòng)脈水平、及腹主動(dòng)脈遠(yuǎn)端共6個(gè)平面,分別對(duì)主動(dòng)脈、夾層真腔、夾層假腔的長徑、短徑、面積進(jìn)行測(cè)量,計(jì)算真腔壓縮指數(shù)(Ci)、真腔有效擴(kuò)張面積(EEA)及有效擴(kuò)張面積比(EER),分析術(shù)前術(shù)后6個(gè)平面上各項(xiàng)指標(biāo)有無統(tǒng)計(jì)學(xué)差異,綜合判定置入錐型人工覆膜支架后,主動(dòng)脈各個(gè)層面的重塑效果,從而評(píng)判使用錐型支架行TEVAR術(shù)治療慢性TBAD的有效性和可行性。結(jié)果：主動(dòng)脈峽部水平面和降主動(dòng)脈遠(yuǎn)端術(shù)后1月真腔短徑較術(shù)前顯著增加(P0.01)；主動(dòng)脈峽部水平面和降主動(dòng)脈中部術(shù)后1月假腔短徑較術(shù)前明顯減小(P0.01)；各水平面真腔面積術(shù)后1月均大于術(shù)前(P0.01)；主動(dòng)脈峽部水平面、降主動(dòng)脈中部及降主動(dòng)脈遠(yuǎn)端水平面術(shù)后1月假腔面積小于術(shù)前(P0.01)；各測(cè)量水平面Ci值均升高(P0.05)；主動(dòng)脈峽部、降主動(dòng)脈中段及降主動(dòng)脈遠(yuǎn)端EEA增加明顯,而EER在各水平面均有不同程度升高。結(jié)論：使用錐型支架治療慢性Stanford B型夾層術(shù)后覆膜支架主要覆蓋區(qū)域(主動(dòng)脈峽部、降主動(dòng)脈中部、降主動(dòng)脈遠(yuǎn)端)主動(dòng)脈真腔通量變化顯著,各個(gè)測(cè)量水平面主動(dòng)脈形態(tài)學(xué)重塑效果良好；主動(dòng)脈真腔面積在衡量TEVAR術(shù)后主動(dòng)脈通量改變相較于測(cè)量真腔直徑更為敏感。
[Abstract]:Objective: to measure and observe the geometric parameters of different plane true and false lumen of aorta before and after operation, and to evaluate the efficacy of (TEVAR) in treating chronic aortic dissection B with conic stent. Objective: to investigate the morphological remodeling of aorta after operation. Materials and methods: from January 2012 to January 2015, 27 patients with chronic Stanford B type aortic dissection treated with conic stent were enrolled in the first affiliated Hospital of Kunming Medical University, Yunnan Province. After CTA scanning, the aortic isthmus was selected. At the middle end of descending aorta, distal descending aorta, celiac trunk level, renal artery level and distal abdominal aorta, the length, short diameter and area of aorta, dissecting true cavity and dissecting false lumen were measured respectively. The true cavity compression index (Ci), the effective expansion area (EEA) and the effective expansion area ratio (EER), were calculated to determine whether there were statistical differences in the six planes before and after the operation, and after the placement of the cone-shaped artificial membrane-covered stent, the difference was statistically significant. To evaluate the effectiveness and feasibility of conic stent TEVAR in the treatment of chronic TBAD. Results: 1 month after operation, the horizontal level of aorta isthmus and the short true lumen diameter of descending aorta were significantly increased (P0.01), and the short diameter of false lumen at the level of aortic isthmus and the middle part of descending aorta 1 month after operation were significantly lower than those before operation (P0.01). 1 month after operation, the true cavity area of each horizontal plane was larger than that before operation (P0.01), and the false lumen area of aortic isthmus level, the middle of descending aorta and the distal horizontal plane of descending aorta was smaller than that of preoperative one month after operation (P0.01). Civalue of each measured level increased significantly (P0.05), and EEA increased significantly in aorta isthmus, middle descending aorta and distal descending aorta, while EER increased in different degrees at each horizontal level. Conclusion: after the treatment of chronic Stanford B dissecting with cone stents, the aortic true lumen flux changes significantly in the covered area (aortic isthmus, middle descending aorta, distal descending aorta). The morphological remodeling of horizontal aorta was better than that of normal control group (P < 0.05). Aortic true lumen area is more sensitive than true lumen diameter in measuring aortic flux after TEVAR.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.3

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