本文選題：升主動脈 + 主動脈弓��； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:本課題通過血管影像工作站對主動脈CT血管造影(CTA)進行觀察,并對主動脈及弓上分支血管進行一系列測量,進而了解升主動脈、主動脈弓以及弓上分支的解剖形態(tài)學特征,為升主動脈及主動脈弓部的腔內移植物的設計、介入治療技術的發(fā)展建立解剖形態(tài)學基礎。方法:按排除標準收集2016年1月~12月在我院進行CTA檢查的患者240例,使用AW4.6工作站對CT圖像進行多種后處理,獲得主動脈及主動脈弓上分支血管的三維圖像,按弓上分支類型將主動脈弓分為正常型和變異型,對187例正常型主動脈及弓上分支血管的直徑、長度、角度及距離進行測量。使用SPSS22.0統(tǒng)計學軟件分析獲得的數(shù)據(jù)。結果與分析:一、正常型主動脈的測量與分析:1、主動脈弓的分型結果:(1)240例病人中,正常型共187例,占77.92%,男性正常型出現(xiàn)率為79.22%,女性正常型出現(xiàn)率為75.58%,在性別上差異無統(tǒng)計學意義(P0.05);變異型共53例,BCT與LCCA共干型31例,占58.50%,LVA直接發(fā)自主動脈弓型21例,占39.62%,BCT與LCCA共干合并LVA直接發(fā)自主動脈弓型1例,占1.88%。(2)187例正常型主動脈中I型弓93例,II型弓82例,III型弓12例,各型主動脈弓在各年齡段的分布不全相同,差異有統(tǒng)計學意義(P0.05)2、正常型主動脈的測量結果(均值±標準差):(1)主動脈直徑:冠狀動脈(CA)開口以遠20mm處D1(32.74±4.52)mm,CA開口以遠40mm處D2(34.17±4.90)mm,主動脈弓近端D3(32.11±4.11)mm,頭臂干(BCT)與左頸總動脈(LCCA)之間D4(30.23±3.95)mm,LCCA與左鎖骨下動脈(LSA)之間D5(28.16±3.30)mm,LSA以遠20mm處D6(26.27±3.35)mm;(2)主動脈長度:CA開口至BCT開口L1(72.70±12.80)mm,CA開口至LCCA開口L2(87.19±14.02)mm,CA開口至LSA開口L3(103.48±17.17)mm;(3)主動脈角度:升主動脈彎曲角度(37)(111.69±14.25)°,主動脈弓與矢狀面夾角q(23.83±6.31)°。3、主動脈參數(shù)的統(tǒng)計分析:(1)D6、L2、L3男性大于女性,差異存在統(tǒng)計學意義(P0.05),其余測量數(shù)據(jù)男女分組間差異均無統(tǒng)計學意義。(2)在19~40歲,41~60歲,61歲以上三個年齡組中,D1~D6、L2、L3均隨著年齡的增長而增大,差異存在統(tǒng)計學意義(P0.05);在41~60歲、61歲以上兩組中,L1均大于19~40歲年齡組,而Φ均小于19-40歲年齡組,差異存在統(tǒng)計學意義(P0.05);在19~40歲、41~60歲兩組中θ均大于61歲以上年齡組,差異存在統(tǒng)計學意義(P0.05)。其余變量年齡分層間差異無統(tǒng)計學意義。二、正常型主動脈弓上分支的測量與分析:1、主動脈弓上分支的測量結果(均數(shù)±標準差):(1)弓上分支血管直徑:BCT開口及開口以遠20mm處d1(15.31±2.37)mm、d2(12.45±2.09)mm,LCCA開口及開口以遠20mm處d3(11.86±2.19)mm、d4(7.70±1.19)mm,LSA開口及開口以遠20mm處d5(13.62±1.94)mm、d6(9.36±1.37)mm;(2)弓上分支血管長度和距離:BCT開口至右鎖骨下動脈(RSA)起始處L4(37.77±9.18)mm,LSA至左椎動脈(LVA)起始處L5(42.78±11.75)mm,BCT-LCCA間距S1(4.04±2.59)mm,LCCA-LSA間距S2(8.71±4.35)mm;(3)弓上分支與弓主干夾角:BCT、LCCA、LSA與弓成角分別為α(29.54±12.89)°、β(40.57±16.91)°、γ(58.48±21.80)°;(4)I型主動脈弓上分支間相對位置參數(shù):三分支夾角λ(144.44±9.74)°,LCCA中心距BCT-LSA中心連線的距離R(4.60±1.21)mm。2、弓上分支參數(shù)的統(tǒng)計分析:(1)d3、d4、d5、d6、L4、L5、S2均男性大于女性,差異存在統(tǒng)計學意義(P0.05),其余弓上三分支參數(shù)男女分組間差異無統(tǒng)計學意義。(2)在19~40歲、41~60歲、61歲上三個年齡組中,d1、d2、d4均隨著年齡的增長而增大,而α、γ均隨著年齡的增長而減小,差異存在統(tǒng)計學意義(P0.05);在41~60歲、61歲以上兩組中,d3、d5、d6、S2、R均大于19~40歲年齡組,而λ小于19~40歲年齡組,差異存在統(tǒng)計學意義(P0.05);在19~40、41~60歲年齡組中,L4、L5均小于61歲以上年齡組,差異存在統(tǒng)計學意義(P0.05)。其余變量年齡分層間差異無統(tǒng)計學意義。通過對187例正常型主動脈的測量,獲得了較為詳細的升主動脈、主動脈弓以及弓上分支的形態(tài)學參數(shù),并且通過性別、年齡分層進行統(tǒng)計學分析發(fā)現(xiàn)主動脈形態(tài)變化的一些規(guī)律,具有重要的臨床意義。以上這些參數(shù)還可為新型腔內移植物、人工血管的設計制作提供詳細的參考信息。
[Abstract]:Objective: To observe the CT angiography (CTA) of the aorta and the branch vessels of the aorta and arch in order to understand the anatomical features of the ascending aorta, the aortic arch and the upper arch of the arch, and to design the endovascular graft for the ascending aorta and the aortic arch and to intervene in the interventional therapy. Methods: to establish the anatomical basis for the development of the technology. Methods: 240 patients with CTA examination in our hospital during ~12 month of January 2016 were collected according to the exclusion criteria. The CT images were processed by AW4.6 workstations, and the three-dimensional images of the branches of the aorta and aorta were obtained. The aortic arch was divided into normal type and change according to the type of arch on the arch. Heterotypy, measured the diameter, length, angle and distance of 187 normal aortic and arch branches. Data obtained by SPSS22.0 statistics. Results and analysis: (1) the measurement and analysis of the normal type aorta: 1, the classification results of the aortic arch: (1) in 240 patients, 187 cases, 77.92% of normal men, and normal men. The incidence rate was 79.22%, the normal female appearance rate was 75.58%, there was no statistical difference in sex (P0.05), 53 cases of variant type, 31 cases of common dry type of BCT and LCCA, 21 cases of aortic arch type, 39.62%, BCT and LCCA combined with LVA direct spontaneous aortic arch type 1 cases, which accounted for I type in 187 normal aorta of 1.88%. (2). 93 cases of arches, 82 cases of II type arch and 12 cases of III type arch, the distribution of various types of aortic arch in all ages was not identical, the difference was statistically significant (P0.05) 2, the measurement results of normal type aorta (mean mean standard deviation): (1) aorta diameter: the opening of the coronary artery (CA) was far 20mm D1 (32.74 + 4.52) mm, CA opening far 40mm D2 (34.17 + 4.90) mm, aorta D3 (32.11 + 4.11) mm, D4 (30.23 + 3.95) mm between the head brachial trunk (BCT) and left common carotid artery (LCCA), D5 (28.16 + 3.30) mm between LCCA and left subclavian artery (LSA), LSA distal 20mm (26.27 + 3.35); (2) the length of the aorta (72.70 + 12.80) 3.48 + 17.17) mm; (3) aortic angle: ascending aorta bending angle (37) (111.69 + 14.25) degrees, aortic arch and sagittal angle Q (23.83 + 6.31).3, statistical analysis of aortic parameters: (1) D6, L2, L3 men were larger than women, the difference was statistically significant (P0.05), and the rest of the measured data between men and women were not statistically significant. (2) in 19~40 41~60 years old, 41~60 years old, three age groups over 61 years old, D1~D6, L2, L3 increased with age, the difference was statistically significant (P0.05). In two groups of age 61 years old, L1 was larger than the age group of 19~40, and the diameter was smaller than the age group of 19-40 years, and the difference was statistically significant (P0.05); in 19~40 years old, 41~60 years two groups were both 61 years older than 61 years old The difference was statistically significant (P0.05). Two, the measurement and analysis of the upper branches of the normal aortic arch: 1, the measurement results of the branch of the aortic arch (1) the diameter of the upper branch of the arch: BCT opening and opening far 20mm D1 (15.31 + 2.37) mm, D2 (12.45) + 2.09) mm, LCCA opening and opening at 20mm, D3 (11.86 + 2.19) mm, D4 (7.70 + 1.19) mm, LSA opening and opening at 20mm D5 (13.62 + 1.94) mm, D6 (9.36 + 1.37); (2) the length and distance of the branches of the arch: from the opening to the beginning of the right subclavian artery (37.77 + 9.18) CA spacing S1 (4.04 + 2.59) mm, LCCA-LSA spacing S2 (8.71 + 4.35) mm; (3) the angle of the upper branch of the arch and the arch trunk: BCT, LCCA, LSA and arch angle, respectively, alpha (29.54 + 12.89) degrees, beta (40.57 + 16.91) degrees, and gamma (58.48 +) degrees; (4) I type aortic arch relative position parameters: the three branch angle lambda [144.44 +] degrees, LCCA center to BCT-LSA center line. R (4.60 + 1.21) mm.2, statistical analysis of the branching parameters on the arch: (1) D3, D4, D5, D6, L4, L5, and S2 were all greater than women, and there was a statistical difference (P0.05), and there was no statistical difference between the three branch parameters on the other bow. (2) in 19~40 years, 41~60 years and 61 years old, they all increased with age. While alpha, gamma decreased with age, and the difference was statistically significant (P0.05). In the two groups over 61 years old, D3, D5, D6, S2, R were all larger than those of 19~40 age group, and the difference was statistically significant (P0.05), and the difference was less than 61 years old in the 19~ 40,41~60 age group. Learning significance (P0.05). There was no statistical significance in the age stratification of the other variables. By measuring 187 normal types of aorta, the morphological parameters of the ascending aorta, the aortic arch and the upper branch of the arch were obtained, and some laws of the morphological changes of the aorta were found by sex and age stratification. These parameters can also provide detailed reference information for the design and manufacture of new type of endovascular graft and artificial blood vessel.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R322.1;R654

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