本文關(guān)鍵詞： 下腔靜脈濾器 異常 CT　出處：《南京醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：多層螺旋CT （multi-slice spiral CT）評(píng)估下腔靜脈濾器（inferior venacava filter，IVCF）置入后濾器傾斜和穿孔的臨床價(jià)值。 方法：本文收集了2011年1月至2012年10月獲得CT隨訪資料的78例下腔靜脈濾器植入術(shù)病例，回顧性評(píng)估濾器置入后隨訪期間發(fā)生濾器異常的CT表現(xiàn)，濾器置入的時(shí)間范圍為1996年6月至2012年10月。78例患者中，女性45例（58％），男性33例（42％），平均年齡為38±9歲（16-75歲）。首次隨訪時(shí)間為濾器置入術(shù)后的12天-16年。CT增強(qiáng)掃描采用間接法、直接法MSCT血管成像,在后處理工作站進(jìn)行多平面重建（multiplanar reformation, MPR）、容積再現(xiàn)（volume rendering,VR）、最大密度投影（maximum intensity projection, MIP）方法后處理。分別在CT冠狀面、矢狀面重建圖像上測(cè)量濾器側(cè)方及前后方向的傾斜角。下腔靜脈穿孔程度的分級(jí)根據(jù)已公布的分級(jí)系統(tǒng)[3]：0級(jí)，濾器全部支撐桿均局限在下腔靜脈管腔內(nèi)；1級(jí)，支撐桿剛好要穿出但仍緊靠下腔靜脈壁；2級(jí)，支撐桿完全在下腔靜脈管腔以外；3級(jí)，濾器的支撐桿貼近或刺入鄰近臟器或腹膜后結(jié)構(gòu)。統(tǒng)計(jì)學(xué)處理采用SPSS11.5統(tǒng)計(jì)軟件，比較下腔靜脈濾器15度傾斜角在前后方向及側(cè)方傾所占比例有無差異采用四格表的確切概率法計(jì)算， p0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果78例患者濾器置入時(shí)間為12天—16年，，濾器發(fā)生傾斜的共22例，17例傾斜角大于15°。濾器側(cè)方傾斜的平均傾斜角為9°±2°，15例大于15°；前后方傾斜的平均傾斜角為10°±3°，10例大于15°；9例濾器僅表現(xiàn)在一個(gè)方向上傾斜角度大于15°；8例濾器雙向傾斜角度均大于15°。濾器15°傾斜角在單純側(cè)方及前后方向所占比例無顯著差異（p=0.5）。CT圖像發(fā)現(xiàn)下腔靜脈穿孔0-1級(jí)共71例，3-4級(jí)共7例，其中0級(jí)，68例，1級(jí)3例；2級(jí)3例；3級(jí)4例。 結(jié)論多排螺旋CT能夠較清晰地呈現(xiàn)下腔靜脈濾器全貌并檢測(cè)異常，可作為對(duì)濾器置入術(shù)后并發(fā)癥及隨訪的有效方法。
[Abstract]:Objective: to evaluate the inferior venacava filter with multi-slice spiral CT. Clinical value of oblique and perforated filter after IVCFS implantation. Methods: 78 cases of inferior vena cava filter implantation were collected from January 2011 to October 2012. Ct findings of abnormal filters during follow-up were retrospectively evaluated. The time range of filter implantation was from June 1996 to October 2012 in 78 patients. There were 45 cases in females and 33 cases in males. The mean age was 38 鹵9 years old and 16-75 years old. The first follow-up time was from 12 days to 16 years after the filter implantation. Ct enhanced scanning was indirect and direct MSCT angiography was performed. Multiplanar reconstruction was performed on a postprocessing workstation with multiplanar reformation, volume volume rendering. The maximum intensity projection (MIP) method was performed on the CT coronal plane. Sagittal reconstruction images measure the oblique angles of the side and front of the filter. Classification of perforation of inferior vena cava according to the published classification system [3] in grade 0, all the support rods of the filter were confined to the inferior vena cava; In grade 1, the support rod is just about to go through but still close to the inferior vena cava wall; Grade 2, the supporting rod is completely outside the inferior vena cava; In grade 3, the supporting rod of the filter was close to or punctured into the adjacent organ or retroperitoneal structure. SPSS11.5 software was used for statistical processing. To compare the difference of the gradient angle of 15 degrees of inferior vena cava filter in the front and back direction and the proportion of lateral tilting, the exact probability method of four grid table was used to calculate the difference. The difference was statistically significant (p0.05). Results the insertion time of filter was 12 days to 16 years in 78 patients. The tilting angle was more than 15 擄in 22 cases and the average angle was 9 擄鹵2 擄in 17 cases. 15 cases were more than 15 擄; The average inclination angle of anterior and posterior tilting was 10 擄鹵3 擄in 10 cases > 15 擄. In 9 cases, the filter was inclined more than 15 擄in one direction. The bidirectional tilting angle of filter was greater than 15 擄in 8 cases. Ct images revealed 0-1 grade inferior vena cava perforation in 71 cases. There were 7 cases of grade 3-4, of which 68 cases were grade 0 and 3 cases were grade 1. Grade 2: 3 cases; Grade 3: 4 cases. Conclusion Multi-slice spiral CT can clearly present the whole picture of inferior vena cava filter and can be used as an effective method for postoperative complications and follow-up.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R816.2

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