本文選題：肺靜脈　切入點：左心房　出處：《泰山醫(yī)學院》2013年碩士論文　論文類型：學位論文

【摘要】：目的 綜合應(yīng)用雙源Flash CT多種后處理方式，顯示肺靜脈解剖及其變異類型，并對其進行分析歸類，統(tǒng)計不同解剖分型的出現(xiàn)率，為臨床提供準確肺靜脈的解剖學信息，用于指導房顫導管消融手術(shù)的準確定位。 方法 從臨床疑診冠狀動脈粥樣硬化性心臟病、主動脈疾病或因體格檢查而接受雙源Flash CT冠狀動脈成像的受檢者中，篩除其中存在可能影響肺靜脈解剖形態(tài)的疾病或既往有心臟、肺部手術(shù)史的患者，對300例樣本進行回顧性分析，其中男性210例，女性90例，年齡14歲~81歲，平均年齡54.8歲。選取最佳舒張期數(shù)據(jù)傳輸至后處理工作站，以原始橫斷面CT圖像為基礎(chǔ)，采用容積再現(xiàn)（VR）、最大密度投影（MIP）及多平面重組（MPR）等重組方式，為減少某些局限因素所引起的誤差，特別引入CT仿真內(nèi)窺鏡技術(shù)（CTVE），由左心房腔內(nèi)觀察肺靜脈間嵴的位置、形態(tài)。綜合應(yīng)用DSCT多種后處理方法，觀察肺靜脈解剖及其變異情況，統(tǒng)計各種分型的出現(xiàn)率。 結(jié)果 研究結(jié)果表明，300例樣本中，共116例患者存在肺靜脈解剖變異，總變異率為38.7%。其中左肺靜脈變異率為20.3%（61/300），右肺靜脈變異率為24%（72/300），經(jīng)x2檢驗得出左、右兩側(cè)肺靜脈變異率無統(tǒng)計學差異。依據(jù)肺靜脈開口數(shù)目的不同、副肺靜脈及肺靜脈共干出現(xiàn)情況，具體將其分為4種類型：①標準型：最常見，共184例（61.3%）；②肺靜脈共干型：共52例（17.3%），根據(jù)位置不同又進一步分出左肺靜脈共干型41例（13.6%）、右肺靜脈共干型10例（3%）、雙側(cè)肺靜脈共干型1例（0.3%）；③副肺靜脈型：共出現(xiàn)48例（16%），其中左副肺靜脈型2例（0.67%）、右副肺靜脈型37例（12.3%），頂上肺靜脈型9例（3%）；④復合變異型共出現(xiàn)16例（5.3%）：均為左肺靜脈共干同時合并1條副肺靜脈。 結(jié)論 研究結(jié)果表明，肺靜脈解剖結(jié)構(gòu)變異率較大，最常見的變異類型為肺靜脈共干型，其次為副肺靜脈型。在肺靜脈解剖及其變異研究過程中，雙源Flash CT的多種后處理方法各有利弊，綜合應(yīng)用多種后處理方法進行分析，可以對肺靜脈解剖結(jié)構(gòu)進行較準確分型。 意義 綜合運用雙源Flash CT多種后處理方式，直觀、立體的觀察肺靜脈與左心房解剖結(jié)構(gòu)關(guān)系，明確其是否存在解剖變異。對于某些細微解剖結(jié)構(gòu)，特別引入CT仿真內(nèi)窺鏡進行觀察，以提高診斷的準確性。通過對肺靜脈進行解剖分型，，詳細統(tǒng)計各分型的出現(xiàn)率，不僅對肺靜脈解剖學研究起到一定的補充，更有助于指導房顫射頻消融及心胸外科手術(shù)，減少術(shù)后并發(fā)癥的發(fā)生。
[Abstract]:Purpose. Multiple post-processing methods of dual-source Flash CT were used to display the anatomy of pulmonary vein and its variation types, and to analyze and classify them, and to calculate the occurrence rate of different anatomical types, so as to provide accurate anatomical information of pulmonary vein in clinic. It is used to guide the accurate localization of catheter ablation for atrial fibrillation. Method. From clinically suspected patients with coronary atherosclerotic heart disease, aortic disease, or double-source Flash CT coronary angiography for physical examination, the presence of a disease that may affect the anatomical morphology of the pulmonary vein or the presence of a previous heart were screened. A retrospective analysis was performed on 300 patients with pulmonary surgery history, including 210 males and 90 females, aged 14 years or 81 years, with an average age of 54.8 years. The best diastolic data were transferred to a post-processing workstation. Based on the original cross-sectional CT images, the methods of volume reconstruction, maximum density projection (MIP) and multiplanar recombination (MPRR) are used to reduce the errors caused by some limited factors. In particular, CT virtual endoscopy was introduced to observe the position and morphology of pulmonary intervenous crest in left atrium, and to observe the anatomy and variation of pulmonary vein by using various post-processing methods of DSCT, and to calculate the occurrence rate of various types. Results. The results showed that 116 out of 300 samples had anatomical variation of pulmonary vein, the total variation rate was 38.7%, in which the variation rate of left pulmonary vein was 20.3 / 300%, and the variation rate of right pulmonary vein was 2472% 300%. The left pulmonary vein was found to be left by x2 test. There was no statistical difference in the variation rate of right and bilateral pulmonary veins. According to the number of pulmonary vein openings, the common trunk of accessory pulmonary vein and pulmonary vein were divided into 4 types: 1 standard type: the most common. A total of 184 cases (61.3 / 2) had common trunk of pulmonary vein: 52 cases (17.3%). According to the position, 41 cases were further divided into left pulmonary vein type and 13.6 trunk type, 10 cases were right pulmonary vein common trunk type, and 1 case was bilateral pulmonary vein common trunk type 1 case was 0.33% accessory pulmonary vein type: there were 48 cases with 16.3 lumen, 48 cases with right pulmonary vein common trunk type, 4 cases with right pulmonary vein common trunk type, 1 case with bilateral pulmonary vein common trunk type, 1 case with bilateral pulmonary vein common trunk type. There were 2 cases with left accessory pulmonary vein, 37 cases with right accessory pulmonary vein, and 9 cases with superior parietal pulmonary vein. Conclusion. The results showed that the variation rate of the anatomical structure of pulmonary vein was large, the most common type of variation was common trunk type of pulmonary vein, and the second type was accessory pulmonary vein type. Multiple post-processing methods of dual-source Flash CT have their own advantages and disadvantages. The anatomical structure of pulmonary vein can be classified accurately by comprehensive analysis of various post-processing methods. Meaning. Multiple post-processing methods of dual-source Flash CT were used to observe the relationship between pulmonary vein and left atrial anatomical structure directly and stereoscopically, and to determine whether there was anatomic variation or not. For some fine anatomical structures, CT virtual endoscopy was introduced to observe them. In order to improve the accuracy of diagnosis, through anatomical classification of pulmonary veins and detailed statistics of the occurrence rate of each type, not only the anatomical study of pulmonary veins is supplemented, but also the radiofrequency ablation of atrial fibrillation and cardiothoracic surgery can be guided. The incidence of postoperative complications was reduced.
【學位授予單位】：泰山醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R541.75;R816.2

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