51例患者后交通动脉起始部膨大的临床研究

发布时间：2018-03-01 02:06

本文关键词： 后交通动脉起始部膨大 DSA 破裂　出处：《浙江大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的获取浙江大学附属第一医院神经外科基于颅脑数字减影血管造影(Digital Subtraction Angiography,DSA)的后交通动脉起始部膨大(posterior communicating artery infundibular dilatation,Pcom-ID)发病率,描述Pcom-ID患者的临床特征,分析Pcom-ID形成的危险因素,探讨颅脑计算机断层扫描血管造影(Computed Tomography Angiography,CTA)对Pcom-ID的诊断价值及提高诊断正确率的方法,回顾特殊病例,总结Pcom-ID患者的预后及转归,以增强对Pcom-ID的认识,为临床的诊断及治疗提供理论支持。方法收集2014年1月-2016年1月于浙江大学附属第一医院神经外科行颅脑DSA患者的临床资料,根据纳入标准与排除标准,获得发病率；通过与正常组的比较,获得发病危险因素；以颅脑DSA为金标准,评估颅脑CTA的诊断正确率,并更改方法,验证其有效性；回顾分析特殊病例,总结病例特点、预后及转归。结果本研究共纳入857例行颅脑DSA造影患者,发现Pcom-ID患者51例,发病率为5.9%。在Pcom-ID患者中,男性占31.37%,女性占68.63%；平均年龄54岁,集中分布在40-70岁之间；‘27.45%有吸烟史,,17.65%有饮酒史；43.14%有高血压史；3.92%有糖尿病史；54.90%合并动脉瘤,其中25.49%为对侧后交通动脉瘤；64.71%位置处于颅脑左侧,27.45%位于右侧,7.84%为双侧；Pcom-ID发展为动脉瘤患者2例,疑似Pcom-ID破裂1例；Pcom-ID更倾向发生于年龄偏大的女性患者,高血压为Pcom-ID发生的危险因素；颅脑CTA对Pcom-ID的诊断正确率为21.21%,方法改良后的诊断正确率为36.36%。结论本中心基于DSA的Pcom-ID发病率为5.9%,好发于40-70岁,多伴有动脉瘤,女性、年龄及高血压为Pcom-ID的危险因素,颅脑CTA对Pcom-ID的诊断及随访价值不大,但通过改变CTA的窗宽、窗位,调整观察角度,结合Pcom-ID的形态学特征,可以提高颅脑CTA对Pcom-ID的诊断正确率,另外,Pcom-ID可以直接发生破裂,也可在膨大壁上长出水泡样结构,水泡样结构可以发生破裂,膨大亦会演变为动脉瘤,发生破裂。
[Abstract]:Objective to obtain the incidence of posterior communicating artery infundibular dilatation Pcom-IDD in neurosurgery department of the first affiliated Hospital of Zhejiang University based on digital subtraction angiography (DSA) of posterior communicating artery, to describe the clinical characteristics of Pcom-ID patients and to analyze the risk factors of Pcom-ID formation. To explore the diagnostic value of computed Tomography angiography (CTA) for Pcom-ID and to improve the diagnostic accuracy of Pcom-ID, to review the special cases and to summarize the prognosis and outcome of Pcom-ID patients, so as to enhance the understanding of Pcom-ID. Methods the clinical data of patients with craniocerebral DSA were collected from January 2014 to January 2016 in the first affiliated Hospital of Zhejiang University. Compared with the normal group, the risk factors were obtained, the diagnostic accuracy of craniocerebral CTA was evaluated with DSA as the gold standard, and the method was changed to verify its validity, and the special cases were analyzed retrospectively, and the characteristics of the cases were summarized. Results in this study, we included 857 patients with craniocerebral DSA angiography. 51 cases of Pcom-ID were found, the incidence rate was 5.90.There were 31.37 males and 68.63 females in Pcom-ID patients, with an average age of 54 years. 27.45% of patients aged 40 to 70 years old had a history of smoking and 17.65% had a history of drinking alcohol. 43.14% had a history of hypertension and 3.92% had a history of diabetes mellitus (54.90%) with aneurysms. 25.49% of the aneurysms were located on the left side of the brain in 64.71% of the patients. 7.84% of the patients were in the right side of the brain. 2 patients with bilateral Pcom-ID developed into aneurysms. One case of suspected rupture of Pcom-ID was more likely to occur in older female patients. Hypertension was the risk factor of Pcom-ID, the correct rate of diagnosis of Pcom-ID by craniocerebral CTA was 21.21, and the correct rate of improved method was 36.36.Conclusion the incidence rate of Pcom-ID based on DSA in this center is 5.9%, which usually occurs between 40 and 70 years old, most of them are accompanied by aneurysms. Age and hypertension were the risk factors of Pcom-ID. Craniocerebral CTA was of little value in the diagnosis and follow-up of Pcom-ID. However, by changing the window width and window position of CTA, adjusting the observation angle and combining with the morphological characteristics of Pcom-ID, the diagnostic accuracy of CTA in Pcom-ID could be improved. In addition, Pcom-ID can rupture directly, blister-like structure can also grow on the expanded wall, blister-like structure can be ruptured and dilated into aneurysm, ruptured.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743

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