本文選題：動(dòng)脈瘤 + 夾層　； 參考：《安徽醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的主動(dòng)脈夾層（aortic dissectionAD）是主動(dòng)脈疾病中最常見(jiàn)的重癥病。主動(dòng)脈夾層是由于主動(dòng)脈內(nèi)膜破裂，主動(dòng)脈腔內(nèi)的血液進(jìn)入主動(dòng)脈中膜，并沿主動(dòng)脈長(zhǎng)軸方向延伸剝離，最終導(dǎo)致主動(dòng)脈真假腔分離、擴(kuò)展累及主動(dòng)脈主要分支血管造成血液灌注不良。目前，CT血管造影及數(shù)字減影血管造影已廣泛應(yīng)用診斷主動(dòng)脈夾層，但兩者診斷主動(dòng)脈夾層的一致性尚不明確，本研究的目的是探討CTA和DSA診斷主動(dòng)脈夾層的一致性及對(duì)主動(dòng)脈夾層腔內(nèi)修復(fù)術(shù)(thoratic endovascularaortic repair TEVAR)的指導(dǎo)意義。 方法回顧性分析安徽醫(yī)科大學(xué)附屬省立醫(yī)院2009年6月至2010年12月期間先后行CTA和DSA檢查的40例B型急性主動(dòng)脈夾層患者，其中男性37例，女性3例；年齡36～81歲，平均53.67±9.21歲。多排螺旋CT血管造影有多種技術(shù)特點(diǎn)，如多平面重建(MPR)、容積再現(xiàn)技術(shù)(VR)、最大密度投影(MIP）、曲面重建(CPR)、表面遮蓋顯示（SSD）等，成像后可清晰地顯示主動(dòng)脈血管的整體觀及形態(tài)走向；DSA被視為診斷主動(dòng)脈夾層動(dòng)脈瘤的金標(biāo)準(zhǔn)。比較CTA和DSA兩種檢查方法在顯示夾層破口、破口的數(shù)目、破口與左鎖骨下動(dòng)脈的距離、左鎖骨下動(dòng)脈平面胸主動(dòng)脈直徑、主動(dòng)脈夾層累及的范圍及主動(dòng)脈主要分支血管的累及情況、真假腔內(nèi)血栓形成及鈣化狀況；34例主動(dòng)脈夾層行主動(dòng)脈夾層腔內(nèi)修復(fù)術(shù)，行覆膜支架后即刻判斷內(nèi)漏的發(fā)生率。 結(jié)果同期行CTA、DSA檢查者40例，兩種檢查方法在檢測(cè)主動(dòng)脈夾層破口數(shù)、破口距LSA的距離、胸主動(dòng)脈直徑方面經(jīng)統(tǒng)計(jì)學(xué)分析顯示無(wú)統(tǒng)計(jì)學(xué)差異。CTA、DSA發(fā)現(xiàn)夾層累及左、右側(cè)髂動(dòng)脈平面的例數(shù)分別為16例(16/40,40.0%)、6例(6/40,15.0%)和15例(15/40,37.5%)、6例(6/40,15.0%)，經(jīng)統(tǒng)計(jì)學(xué)分析，兩種方法在檢測(cè)夾層累及左、右側(cè)髂動(dòng)脈平面均有統(tǒng)計(jì)學(xué)意義(P0.05)。CTA可檢測(cè)出夾層血栓、動(dòng)脈壁鈣化，而DSA無(wú)法顯示。40例主動(dòng)脈夾層患者行主動(dòng)脈夾層腔內(nèi)修復(fù)術(shù)34例，覆膜支架置入后DSA即刻檢測(cè)發(fā)現(xiàn)內(nèi)漏者11例(11/34,32.35%)。 結(jié)論CTA、DSA兩者對(duì)診斷主動(dòng)脈夾層有較好的一致性，DSA的優(yōu)勢(shì)在于術(shù)中實(shí)時(shí)評(píng)估病變情況，精確指導(dǎo)覆膜支架的置放。CTA可以對(duì)AD的術(shù)前各項(xiàng)檢測(cè)指標(biāo)作出較可靠的評(píng)價(jià)并指導(dǎo)擬定手術(shù)方案，且其為無(wú)創(chuàng)，，可重復(fù)性好，可作為術(shù)后隨訪的首選方法。
[Abstract]:Objective Aortic dissection ADA is the most common severe aortic disease. The aortic dissection is caused by the rupture of the aortic intima, the blood in the aortic cavity enters the middle membrane of the aorta and extends along the long axis of the aorta, leading to the separation of the true and false lumen of the aorta. Poor blood perfusion is caused by the expansion of the main branches of the aorta. At present, CT angiography and digital subtraction angiography have been widely used in the diagnosis of aortic dissection. The purpose of this study was to explore the consistency between CTA and DSA in the diagnosis of aortic dissection and its guiding significance in endovascular endovascularaortic repair repair aortic dissection repair. Methods from June 2009 to December 2010, 40 patients with type B acute aortic dissection were examined by CTA and DSA, including 37 males and 3 females, aged 3681 years (mean 53.67 鹵9.21 years). Multislice spiral CT angiography has many technical features, such as multiplanar reconstruction, volumetric reconstruction, maximum density projection (MIP), curved surface reconstruction (CPR), surface shaded display (SSDs), etc. DSA is regarded as the golden standard for the diagnosis of aortic dissecting aneurysm. CTA and DSA were compared in showing the dissecting break, the number of breaks, the distance between the break and the left subclavian artery, and the diameter of thoracic aorta in the plane of the left subclavian artery. The extent of aortic dissection and the involvement of the main branches of aorta, the true and false lumen thrombosis and calcification. 34 cases of aortic dissection underwent endovascular repair of aortic dissection, and the incidence of internal leakage was judged immediately after the stenting. Results 40 cases underwent DSA examination at the same time. The two methods were used to detect the number of aortic dissection, the distance from the break to LSA, and the diameter of thoracic aorta showed no statistical difference. The number of cases in the right iliac artery plane were 16 / 40 / 40 / 40.010 / 6 / 6 / 40 / 15.0) and 15 / 15 / 37.5% / 6 / 6 / 4015.0% respectively. By statistical analysis, there were significant differences between the two methods in detecting the left and right iliac artery levels (P0.05). CTA could detect dissecting thrombosis, calcification of artery wall. However, 34 cases of aortic dissection were treated with endovascular repair of aortic dissection, which could not be seen by DSA. 11 cases with internal leakage were detected by DSA immediately after stent-covered stent implantation, and 11 / 34 cases (32.35%) were found to have internal leakage. Conclusion there is a good consistency between CTA-DSA and DSA in the diagnosis of aortic dissection. The advantage of DSA is to evaluate the lesion in real time during operation. The accurate guidance of placement of covered stent. CTA can be used as the first choice for postoperative follow-up because it can be used to evaluate the preoperative parameters of AD and to draw up the operative plan.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R816.2;R543.1

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