主动脉弓主要分支的解剖及相关变异的MSCT研究

发布时间：2018-01-19 07:10

本文关键词： 主动脉弓变异解剖测量体层摄影术 CTA　出处：《天津医科大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的本研究通过多层螺旋CT血管成像对人体在体主动脉弓凸侧分支血管进行分析,观察主动脉弓分支的相关变异,标准型主动脉弓的三个分支血管即头臂干动脉、左颈总动脉及左锁骨下动脉在主动脉弓的分支位置,并对标准型主动脉弓的三个分支进行相关解剖学定量测量,旨在为临床工作提供帮助。资料及方法按照入组标准搜集2009年～2010年的237例颈部多层螺旋CT血管成像图,采用多种图像后处理技术,获得主动脉弓部重组图像进行研究。对所有病例进行容积再现和多平面容积重建(MPR),多角度、多平面、多方位立体观察主动脉弓及其主要分支的解剖结构。对其中211例标准型主动脉弓的病例,记录头臂干动脉、左颈总动脉及左锁骨下动脉在主动脉弓的分支位置。以原始轴位图像为基础,分别确定可显示头臂干动脉与左颈总动脉及左颈总动脉与左锁骨下动脉间距的MPR斜位图像平面与矢状面的夹角,分别做斜位MPR容积重组图像,并以此斜位MPR图像为基础观察容积再现图像,在最佳观测平面上分别测量头臂干动脉与左颈总动脉和左颈总动脉与左锁骨下动脉的间距,并读出头臂干动脉、左颈总动脉、左锁骨下动脉在分支处的直径。使用SPSS17.0软件分析所得标准型主动脉弓的头臂干动脉与左颈总动脉和左颈总动脉与左锁骨下动脉的间距、主动脉弓各分支在分支处的直径,对是否存在年龄及性别差异进行统计学分析。结果①主动脉弓分为两种类型,标准型和变异型,其中标准型最常见,占总病例数的89.03%,变异型为总病例数的10.97%。②变异型中可见四种不同类型的变异。左侧椎动脉自主动脉弓发出并位于左颈总动脉和左锁骨下动脉之间者13例,为变异型患者的50%,为总病例数的5.49%；左颈总动脉自头臂干发出者10例,为变异型的38.46%,为总病例数的4.22%；左颈总动脉发自于头臂干并存左椎动脉发自主动脉弓并位于左颈总动脉和左锁骨下动脉之间者2例,为变异型的7.69%,为总病例数的0.84%；右位主动脉弓伴迷走左锁骨下者1例,为变异型的3.85%,为总病例数的0.42%。③标准型主动脉弓的三分支血管中,头臂干动脉在主动脉弓的开口位置位于主动脉弓后上壁者为87.67%,位于主动脉弓正上壁者为9.48%,位于主动脉弓前上壁者为2.84%；左颈总动脉在主动脉弓的分支开口位置位于主动脉弓后上壁者为7.58%,位于主动脉弓正上壁者为36.97%,位于主动脉弓前上壁者为55.45%；左锁骨下动脉在主动脉弓的分支开口位置位于主动脉弓后上壁者为27.49%,位于主动脉弓正上壁者为60.19%,位于主动脉弓前上壁者为12.32%；④标准型主动脉弓的三个分支血管中,显示头臂干动脉和左颈总动脉间距的平面与矢状面之间的夹角最大值为120.7°,最小值为14.6°,平均角度为71.47°±2.16°,无年龄及性别差异；显示左颈总动脉和左锁骨下动脉间距的平面与矢状面之间的夹角最大值为96.6°,最小值为3.6°,平均角度为30.82°±1.62°,无年龄及性别差异。⑤头臂干动脉与左颈总动脉的间距最大值为19.60mm,最小值为0.80mm,平均值为5.59±0.48mm,无年龄及性别差异；左颈总动脉与左锁骨下动脉最大距离最大值为24.20mm,最小值为0.80mm,平均值为8.76±0.63mm,无年龄及性别差异。⑥头臂干动脉在主动脉弓分支处直径的最大值为19.70mm,最小值为8.10mm,平均值为12.74±0.35mm,无年龄及性别差异；左颈总动脉在主动脉弓分支处的直径最大值为18.0mm,最小值为3.30mm,平均值为8.37±0.29mm,无年龄及性别差异；左锁骨下动脉在主动脉弓分支处的直径最大值为17.00mm,最小值为4.30mm,平均值为10.07±0.31mm,无年龄差异,存在性别差异,女性较男性细。结论：①主动脉弓分支分型为标准型和变异型,其中标准型为总病例数89.03%,变异型为总病例数的10.97%,与既往国内外文献报道相同。②变异型中可分为四种不同类型,各分型所占总病例数的百分比与既往国内外报道的数据相符合。但是,四种变异类型中,左侧椎动脉自主动脉弓发出并位于左颈总动脉和左锁骨下动脉之间者最多,与既往国内外报道的数据不同。③标准型主动脉弓三个分支中,头臂干动脉的分支开口位置多位于主动脉弓的后上壁,左颈总动脉的分支开口位置多位于主动脉弓的前上壁,左锁骨下动脉的开口位置多位于主动脉弓的正上壁。④标准型主动脉弓显示头臂干动脉和左颈总动脉间距的平面与矢状面之间的夹角,最大值为120.7°,最小值为14.6°,平均角度为71.47°±2.16°,无年龄及性别差异；显示左颈总动脉和左锁骨下动脉间距的平面与矢状面之间的夹角,最大值为96.6°,最小值为3.6°,平均角度为30.82°±1.62°,无年龄及性别差异。在选择性造影中,观察头臂干动脉的最佳角度为右前斜位71°,而并不是常规的摄影位置即左前斜位30°。⑤头臂干动脉与左颈总动脉的间距最大值为19.60mm,最小值为0.80mm,平均值为5.59±0.48mm,无年龄及性别差异；左颈总动脉与左锁骨下动脉的间距的最大值为24.20mm,最小值为0.80mm,平均值为8.76±0.63mm,无年龄及性别差异。头臂干动脉与左颈总动脉的平均间距比左颈总动脉与左锁骨下动脉的平均间距小。⑥头臂干动脉在分支处的直径最大值为19.70mm,最小值为8.10mm,平均值为12.74±0.35mm,最粗,无年龄及性别差异；左颈总动脉在分支处的直径最大值为18.0mm,最小值为3.30mm,平均值为8.37±0.29mm,最细,无年龄及性别差异；左锁骨下动脉在分支处的直径最大值为17.00mm,最小值为4.30mm,平均值为10.07±0.31mm,无年龄差异,存在性别差异,女性较男性细。在临床工作中选择血管支架时,在考虑多方面因素后,可根据不同的测量结果选择不同型号的血管支架,以取得最佳效果。
[Abstract]:The purpose of this study by multi-slice spiral CT angiography in the human body in the convex side of the aortic arch branch vessel analysis, correlation observation of aortic arch branch, three branch vessel standard of the aortic arch is brachiocephalic artery and branch position left common carotid artery and left subclavian artery in aortic arch, and three a branch of the standard type of aortic arch were anatomic quantitative measurement, in order to provide help for the clinical work.
Materials and methods according to the inclusion criteria collect 237 cases with neck multislice CT angiography picture from 2009 to 2010, using a variety of image postprocessing techniques, to obtain the aortic arch reconstruction images were studied. By volume rendering and multi planar volume reconstruction in all cases (MPR), multi angle, multi planar, three-dimensional anatomical structure observation of the aortic arch and its main branches.
The branches of the head arm, the left common carotid artery and the left subclavian artery were located in the branches of the aortic arch in 211 cases of the standard aortic arch.
The original axial images, can be displayed respectively to determine the brachiocephalic artery and left common carotid artery and left common carotid artery and left subclavian artery between MPR image plane and oblique sagittal angle respectively, oblique MPR VR, and the oblique MPR images based on the observation volume reconstructed images were measured, brachiocephalic artery spacing and left carotid artery and left common carotid artery and left subclavian artery in the best observation plane, and read head arm artery, left common carotid artery, the diameter of the left subclavian artery at the branch of the head and arm. Analysis of the standard type SPSS17.0 aortic arch the spacing between the artery and the software stem left common carotid artery and left common carotid artery and left subclavian artery, the aortic arch branches at the branch diameter, whether there is age and gender differences were statistically analyzed.
The aortic arch can be divided into two types, standard and variant, one of the most common standard, the total number of cases of 89.03%, the 10.97%. variant is the total number of cases of variant visible in four different types of variation. The left vertebral artery and 13 cases from independent arterial arch is located between the left carotid the artery and the left subclavian artery, for patients with variant 50%, the total number of cases was 5.49%; the left common carotid artery from the brachiocephalic trunk in 10 cases a variant, as of 38.46%, the total number of cases was 4.22%; 2 cases of left common carotid artery from the brachiocephalic trunk both left vertebral artery hair independent arterial arch and is located between the left carotid artery and left subclavian artery, as a variant of the 7.69%, the total number of cases was 0.84%; right aortic arch with aberrant left clavicle were 1 cases, for 3.85% variants, three branch blood 0.42%. standard type aortic arch for the total number of cases. Tube, head Arm trunk artery in the open position of the aortic arch in the aortic arch after the wall is 87.67%, located in the aortic arch is on the wall for 9.48%, located in the anterior wall of aortic arch was 2.84%; branches of the left common carotid artery in aortic arch openings located in the aortic arch after the wall is 7.58%, is located in the aortic arch on the wall is 36.97%, located on the front wall of aortic arch was 55.45%; the branch of left subclavian artery in aortic arch openings located in the aortic arch after the wall is 27.49%, located in the aortic arch is on the wall for 60.19%, located in the anterior wall of aortic arch was 12.32%; three branches of the standard type vessels aortic arch, display brachiocephalic trunk between the maximum angle plane and sagittal artery and left common carotid artery spacing is 120.7 degrees, the minimum value is 14.6 degrees, the average angle is 71.47 degrees - 2.16 degrees, no age and gender differences; left neck The maximum angle between the plane and the sagittal plane spacing of the artery and the left subclavian artery is 96.6 degrees, the minimum value is 3.6 degrees, the average angle is 30.82 degrees - 1.62 degrees, no age and gender differences. The maximum distance between the brachiocephalic artery and left common carotid artery was 19.60mm, the minimum value is 0.80mm, the average value is 5.59 + 0.48mm, no age and gender differences; the left carotid artery and left subclavian artery maximum distance of maximum value is 24.20mm, the minimum value is 0.80mm, the average value is 8.76 + 0.63mm, no age and gender differences. The brachiocephalic artery diameter of the aortic arch branch maximum. 19.70mm, the minimum value is 8.10mm, the average value is 12.74 + 0.35mm, no age and gender differences; the left common carotid artery in aortic arch branch diameter at the maximum value is 18.0mm, the minimum value is 3.30mm, the average value is 8.37 + 0.29mm, no age and gender differences; the left subclavian artery in aortic The maximum diameter of the arch branch is 17.00mm, the minimum value is 4.30mm, the average value is 10.07 + 0.31mm, there is no difference of age, there is sex difference, and the female is thinner than the male.
Conclusion: the aortic arch branch divided into standard and variant, the standard for the total number of cases 89.03%, 10.97% variants for the total number of cases, with previously reported in the literature. The same mutation type can be divided into four different types, with the total number of cases reported for each type% than with the previous domestic and foreign data. However, four types of variation in the left vertebral artery and arterial arch is located between the independent from the left carotid artery and left subclavian artery were the most, unlike previous reports at home and abroad. The standard data type three aortic arch branch, brachiocephalic trunk the arterial branch opening position located in the aortic arch on the wall, the wall branch of the left common carotid artery opening position located in the aortic arch, is on the wall opening position of the left subclavian artery in aortic arch. The standard arch anonyma dynamic display The angle between the plane and the sagittal vein and left carotid artery spacing, the maximum value is 120.7 degrees, the minimum value is 14.6 degrees, the average angle is 71.47 degrees - 2.16 degrees, no age and gender differences; that the angle between the plane and the sagittal plane of left carotid artery and left subclavian artery in the distance and the maximum value is 96.6 degrees, the minimum value is 3.6 degrees, the average angle is 30.82 degrees - 1.62 degrees, no age and gender differences. In selective angiography, the best observation angle of brachiocephalic arteries to right anterior oblique 71 degrees, rather than the conventional camera position is left anterior oblique 30 degrees. Maximum distance between the brachiocephalic artery and left common carotid artery was 19.60mm, the minimum value is 0.80mm, the average value is 5.59 + 0.48mm, no age and gender differences; the left carotid artery and left subclavian artery, the maximum spacing is 24.20mm, the minimum value is 0.80mm, the average value was 8.76 + 0.63mm. No age and gender differences in the head and arm. The average distance between stem artery and left common carotid artery than the average spacing between the left carotid artery and left subclavian artery. The brachiocephalic arteries at the branch of the largest diameter value is 19.70mm, the minimum value is 8.10mm, the average value is 12.74 + 0.35mm, the most thick, no age and gender differences; the left carotid the diameter of the artery at the branch of the maximum value was 18.0mm and the minimum was 3.30mm, the average value is 8.37 + 0.29mm, the fine, no age and gender differences; the left subclavian artery at the branch of the maximum diameter of 17.00mm, the minimum value is 4.30mm, the average value is 10.07 + 0.31mm, there is no age difference. Gender differences in women than in men. The stent in clinical choice of fine work, in consideration of many factors, according to different measurement results to choose different types of stents, to achieve the best results.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322.121;R816.2

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