本文選題：體層攝影術(shù) + X線計(jì)算機(jī)�。� 參考：《重慶醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的：運(yùn)用320排CT一站式檢查探討肝硬化患者上腹部實(shí)質(zhì)器官灌注特征、血管改變及其臨床應(yīng)用價(jià)值。 方法：使用320排容積CT，分別對(duì)45例正常對(duì)照和45例肝硬化患者做上腹部一站式檢查。①使用體部灌注軟件分析，得到肝臟不同肝葉的肝動(dòng)脈灌注量（HAP）、門靜脈灌注量（HPP）動(dòng)脈灌注分?jǐn)?shù)（APF），胰腺不同部位（胰頭、胰體、胰尾）及脾臟的動(dòng)脈灌注量（AP），對(duì)各參數(shù)進(jìn)行統(tǒng)計(jì)學(xué)分析。P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。②使用多平面成像(MPR)、最大密度投影(MIP)、容積再現(xiàn)(VR)，選擇最佳時(shí)相重組增強(qiáng)各期圖像及重組動(dòng)脈血管造影（CTA）、靜脈及門靜脈CT靜脈成像（CTV）和4D-CTA，，直接對(duì)其觀察后評(píng)價(jià)血管的形態(tài)和走形。 結(jié)果：⑴肝硬化組HAP、HPP、APF在各肝葉間均未表現(xiàn)出明顯的統(tǒng)計(jì)學(xué)差異（P0.05），正常對(duì)照組肝左外葉HAP、APF高于肝右葉，HPP低于肝右葉、左內(nèi)葉，差異均有統(tǒng)計(jì)學(xué)意義（P0.05）。與對(duì)照組相比，肝硬化組的HPP降低，HAP、APF增高（P0.01）。正常對(duì)照組胰頭、胰體、胰尾部AP無(wú)明顯統(tǒng)計(jì)學(xué)差異（P0.05）。肝硬化組胰體、胰尾部AP低于胰頭部（P0.01）。肝硬化組胰腺各部位、脾臟的AP低于對(duì)照組（P0.01）。⑵通過(guò)CTA、CTV可清晰顯示肝內(nèi)各血管的解剖和變異。90例肝動(dòng)脈的CTA均顯示了4、5級(jí)正常肝動(dòng)脈，Ⅰ型48例，Ⅱ型7例，Ⅲ型15例，Ⅴ型4例,Ⅵ型5例,Ⅸ型6例，未被列入的其他分型共5例。正常肝靜脈61例，肝中靜脈和肝左靜脈匯合后再注入下腔靜脈18例，肝中靜脈和肝右靜脈匯合后再注入下腔靜脈5例，右下副肝靜脈1例，肝靜脈顯影淺淡5例。正常對(duì)照組門靜脈顯示以4、5級(jí)分支為主，肝硬化組以3、4級(jí)為主。在肝硬化組的45例患者中，31例伴有門靜脈高壓側(cè)支循環(huán)形成。食管下段及食管旁靜脈曲張25例，胃短、胃后及胃左靜脈靜脈曲張20例，臍旁及腹壁淺靜脈曲張16例，胃-腎和脾-腎分流8例，腹膜后分流5例，門靜脈海綿樣變6例。 結(jié)論：320排容積CT一站式檢查，受試者一次性注射造影劑后，經(jīng)一次CT檢查即可獲取覆蓋全上腹部器官同一時(shí)間的灌注數(shù)據(jù)，同步直觀的反映正常人及肝硬化患者上腹部實(shí)質(zhì)器官（肝臟、胰腺、脾臟）的血流灌注特征及血管變化，提供有價(jià)值并幾乎接近生理狀態(tài)的血流動(dòng)力學(xué)信息，具有重要的臨床意義：⑴正常人肝臟各葉的灌注情況不盡相同，胰腺各部位的灌注狀態(tài)一致。肝硬化患者肝內(nèi)灌注差異消失，胰腺、脾臟的灌注降低。⑵CTA、CTV能明確了解肝動(dòng)脈、門靜脈及肝靜脈系統(tǒng)的正常、變異及肝硬化患者有無(wú)門脈高壓以及由此導(dǎo)致的側(cè)枝循環(huán)的開(kāi)放情況，并能直觀顯示并評(píng)估靜脈曲張的部位、數(shù)目、程度及與周圍臟器的關(guān)系等。對(duì)肝硬化門脈高壓的診斷，制定藥物、外科或介入治療計(jì)劃具有重要的臨床意義。
[Abstract]:Objective: To investigate the perfusion characteristics, blood vessel changes and clinical value of upper abdominal parenchymal organs in patients with cirrhosis by using 320 row CT one-stop examination.
Methods: using 320 row volume CT, 45 cases of normal control and 45 patients with cirrhosis were examined on the upper abdomen one station. (1) the volume of hepatic artery perfusion (HAP), portal perfusion (HPP) artery perfusion score (APF), the different parts of pancreas (pancreas head, pancreas body, tail of pancreas) and the splenic arteries were obtained by the analysis of body perfusion software. The amount of perfusion (AP) was statistically analyzed by.P0.05, and the difference was statistically significant. (2) using multiplanar imaging (MPR), maximum density projection (MIP), volume rendering (VR), selecting the best phase recombination enhancement phase images and recombinant arterial angiography (CTA), venous and portal vein CT venography (CTV) and 4D-CTA, directly after observation. To evaluate the shape and shape of the blood vessels.
Results: (1) there was no significant difference in HAP, HPP and APF between liver leaves in the liver cirrhosis group (P0.05). The left external lobe of the normal control group was HAP, APF was higher than the right lobe of the liver, HPP was lower than the right lobe of the liver, and the left internal lobe was statistically significant (P0.05). Compared with the control group, the HPP decreased, HAP, APF increased (P0.01). Normal control group pancreatic head, There was no significant difference between the pancreas body and the tail AP of the pancreas (P0.05). The pancreatic body in the liver cirrhosis group and the tail AP of the pancreas were lower than the head of the pancreas (P0.01). The AP of the pancreas in the liver cirrhosis group and the spleen were lower than the control group (P0.01). (2) through CTA, CTV can clearly show the anatomy and variation of the vessels in the liver, and the CTA of the.90 cases of the hepatic artery in.90 cases all showed the 4,5 normal hepatic artery, type I 48 cases, II. There were 7 cases, 15 cases of type III, 4 cases of type V, 5 cases of type VI, 6 cases of type IX, 5 cases of other types, 61 cases of normal hepatic vein, 18 cases of inferior vena cava after the confluence of the middle hepatic vein and the left vein of the liver, 5 cases of the inferior vena cava after the confluence of the middle hepatic vein and the right vein, 1 cases of the inferior right inferior hepatic vein, and the normal control group of the hepatic vein, and the normal control group. The portal vein was mainly 4,5 grade branch, and the liver cirrhosis group was mainly 3,4. Of the 45 patients with liver cirrhosis, 31 cases were accompanied by high pressure collateral circulation of the portal vein, 25 cases of lower esophagus and paroesophageal varices, 20 cases of gastric short, posterior and gastric varicose veins, 16 cases of umbilicus and abdominal wall superficial varicosity, 8 cases of stomach to kidney and splenic renal shunt. There were 5 cases of posterior diffluence and 6 cases of portal vein cavernous change.
Conclusion: 320 row volume CT one station examination, after a single injection of contrast agent, the subjects can get the perfusion data covering the whole upper abdominal organ at the same time after one time CT examination, and synchronously and intuitively reflect the blood perfusion characteristics and vascular changes of the parenchyma organs of the upper abdomen (liver, pancreas, spleen) of normal people and the patients with liver cirrhosis, and provide the price. The value and almost close to the physiological state of the hemodynamic information, which has important clinical significance: (1) the perfusion of all leaves of the normal human liver is not the same, the perfusion status of the various parts of the pancreas is the same. The hepatic perfusion difference of the patients with liver cirrhosis is disappearing, the perfusion of the pancreas and spleen is reduced. (2) CTA, CTV can clearly understand the hepatic artery, the portal vein and the hepatic vein The normal, variant and cirrhosis patients have portal hypertension and the resulting opening of the collateral circulation, and can intuitively display and evaluate the location, number, degree, and relationship with the surrounding organs. It has important clinical implications for the diagnosis of cirrhosis of the portal hypertension, the formulation of drugs, surgical or interventional therapy. Righteousness.
【學(xué)位授予單位】：重慶醫(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)】：R816.5;R575.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳婷;郭大靜;趙建農(nóng);;全腦CT灌注在腦血管疾病中的臨床應(yīng)用和進(jìn)展[J];重慶醫(yī)學(xué);2012年16期

2 王守安;肝臟的CT灌注成像及臨床應(yīng)用現(xiàn)狀[J];國(guó)外醫(yī)學(xué)(臨床放射學(xué)分冊(cè));2003年06期

3 靳秀麗;楊漢豐;杜勇;徐曉雪;李楊;段如剛;;肝臟的CT灌注成像及其應(yīng)用[J];國(guó)際消化病雜志;2010年01期

4 史麗靜,田建明,李曉兵,李樹(shù)平,陳煒,左長(zhǎng)京,王敏杰;多層螺旋CT肝臟灌注測(cè)量在肝硬化中的初步應(yīng)用[J];臨床放射學(xué)雜志;2005年06期

5 蒙秋華;韓銘鈞;秦培鑫;張潔;張晶;關(guān)文華;;早期肝硬化腎臟MSCT灌注成像的研究[J];臨床放射學(xué)雜志;2009年02期

6 杜飛舟;顧明;關(guān)靜;李建浩;蔣銳;;320排容積CT上腹部一站式檢查初步探討[J];臨床放射學(xué)雜志;2011年08期

7 于永梅;崔宜;王月訓(xùn);;128層4D CT全肝灌注成像在肝細(xì)胞癌中的初步應(yīng)用[J];中國(guó)中西醫(yī)結(jié)合影像學(xué)雜志;2011年01期

8 廖錦元;黃仲奎;龍莉玲;丁可;宋瑞;;肝硬化多層螺旋CT灌注成像臨床研究[J];實(shí)用放射學(xué)雜志;2006年06期

9 徐宏旭;晉輝;;肝硬化胃腸血流的多層螺旋CT灌注研究[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2007年04期

10 陳麗娜;瞿晴;孫波;王蕾;慎睿哲;程時(shí)丹;靳勇;吳云林;;門脈CT血管造影成像和胃鏡在門脈高壓診斷中的價(jià)值[J];世界華人消化雜志;2006年35期

本文編號(hào)：2056073