發(fā)布時間：2018-11-18 19:12

【摘要】：目的探討針對非房顫患者與房顫患者的左心房肺靜脈系統(tǒng)，64層螺旋CT心血管成像及多種三維重組后處理技術的形態(tài)學評價方法與價值。 方法回顧性分析2011年4月-12月期間來同濟醫(yī)院CT室行心血管成像的50例非房顫患者及11例房顫患者的左心房及肺靜脈的結構，房顫患者不分組，非房顫患者按年齡和性別分組，利用工作站的容積再現（VR）、多平面重組（MPR）、仿真血管內窺鏡（VIE）等多種三維重組技術進行后處理，以了解肺靜脈及左心房的形態(tài)學結構；射頻消融術中與電解剖圖像融合，了解術后療效。 結果①利用VR可良好構建肺靜脈的形態(tài)，50例非房顫患者中，44例雙側肺靜脈均為2支（88%）；6例存在變異（12%）；雙上肺靜脈明顯較雙下肺靜脈粗（P0.05），男性左上肺靜脈、右上下肺靜脈均較女性粗（P0.05），左下肺靜脈男女無顯著性差異（P0.05）；中年組和老年組肺靜脈口徑無顯著性差異（P0.05）；雙上肺靜脈開口角度明顯較雙下肺靜脈大（P0.05）。11例房顫患者中，8例雙側肺靜脈均為2支（72.7%）；3例存在變異（27.3%）。②VIE技術良好顯示左側上下肺靜脈開口之間、右側上下肺靜脈開口之間、左心耳開口與左上肺靜脈開口之間的關系，良好顯示左心耳與左上肺靜脈之間界嵴的四種形態(tài)。③VR可良好顯示左心房頂部4種形態(tài)。非房顫患者中，29例為平坦型（58%），，19例為突起型（38%），2例為凹陷型（4%）；測得50例患者左心房平均容積為84.5立方厘米；老年組左心房平均容積明顯較中年組大（P0.05）。男性左心房平均容積較女性大（P0.05）。11例房顫患者中，4例左心房頂部為平坦型，3例為突起型，4例為凹陷型；左房容積平均為108.3立方厘米。④MPR圖測量冠狀竇匯入右房處與矢狀面之間的角度，50例非房顫患者范圍從9.5°到130.9°不等，平均為78.9°。11例房顫患者從67.8°到97.1°，平均為85.9°。在CT與三維電解剖標測系統(tǒng)圖像融合的輔助下，11例房顫患者射頻消融術后恢復竇性節(jié)律，無明顯并發(fā)癥。 結論64層螺旋CT心血管成像多種三維重組后處理技術能夠在術前直接對左心房肺靜脈系統(tǒng)進行形態(tài)學觀察，明確各種形態(tài)學變異等，術中與電解剖標測系統(tǒng)融合，可以為臨床射頻消融治療房顫提供解剖信息。
[Abstract]:Objective to evaluate the morphologic evaluation of left atrial pulmonary vein system, 64-slice spiral CT cardiovascular imaging and three dimensional recombination post-processing techniques in patients with non-atrial fibrillation and atrial fibrillation. Methods the structures of left atrium and pulmonary vein in 50 patients with non-atrial fibrillation and 11 patients with atrial fibrillation were analyzed retrospectively from April to December 2011. The patients with atrial fibrillation were not divided into two groups. Patients with non-atrial fibrillation were divided into groups according to age and sex. (VR), multiplanar reconstituted (MPR), was reconstructed by workstation volume and (VIE) was simulated by vascular endoscope. To understand the morphological structure of pulmonary vein and left atrium. To understand the curative effect of radiofrequency ablation with electroanatomical image fusion. Results (1) the morphology of pulmonary veins could be well constructed by using VR. Of the 50 patients with non-atrial fibrillation, 44 (88%) had 2 pulmonary veins, 6 (12%) had variation. Double superior pulmonary vein was thicker than double inferior pulmonary vein (P0.05), male left superior pulmonary vein, right superior pulmonary vein were thicker than female (P0.05), left inferior pulmonary vein had no significant difference between male and female (P0.05). There was no significant difference in the diameter of pulmonary vein between middle age group and old group (P0.05), the angle of opening of double superior pulmonary vein was significantly larger than that of double inferior pulmonary vein (P0.05). In 11 patients with atrial fibrillation, two pulmonary veins were found in 8 cases (72.7%). There was variation in 3 cases (27.3%). The relationship between left superior and inferior pulmonary vein openings, right superior and inferior pulmonary vein openings, left atrial auricular openings and left superior pulmonary vein openings was well demonstrated by 2VIE technique. Four forms of the boundary ridge between the left atrial auricle and the left superior pulmonary vein were well displayed. 3VR showed the top of the left atrium well. Among the patients with non-atrial fibrillation, 29 cases were flat type (58%), 19 cases were protruding type (38%), 2 cases were concave type (4%), the mean volume of left atrium in 50 cases was 84.5 cubic centimeter. The mean volume of left atrium in the elderly group was significantly larger than that in the middle age group (P0.05). The mean volume of left atrium in male was larger than that in female (P0.05). In 11 patients with atrial fibrillation, 4 cases were flat at the top of left atrium, 3 cases were protruding type and 4 cases were concave type. The mean volume of left atrium was 108.3 cubic centimeters. The angle between the confluence of coronary sinus into the right atrium and sagittal plane was measured by 4MPR. The range of 50 patients with non-atrial fibrillation ranged from 9.5 擄to 130.9 擄. 11 patients with AF ranged from 67.8 擄to 97.1 擄, with an average of 85.9 擄. 11 patients with atrial fibrillation recovered sinus rhythm after radiofrequency ablation with the aid of fusion of CT and 3D electroanatomical mapping system without obvious complications. Conclusion 64-slice spiral CT can be used to observe the left atrial pulmonary vein system directly before operation, and to identify various morphologic variations, and to fuse with the electroanatomical mapping system during the operation. It can provide anatomic information for the treatment of atrial fibrillation by radiofrequency ablation.
【學位授予單位】：華中科技大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R814.42

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