肠系膜上动脉夹角与自发性孤立性肠系膜上动脉夹层相关性研究

发布时间：2018-02-23 12:12

本文关键词： 肠系膜上动脉夹层夹角机制　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景和目的自发性孤立性肠系膜上动脉夹层(spontaneous isolated dissection of the superior mesenteric artery,SIDSMA)曾经被认为是罕见的疾病,本病在1947年被Bauersfeld首次报道,随着多排螺旋CT血管成像(Multi-slice spiral computed tomography angiography,MSCTA)的应用普及,越来越多的自发性孤立性肠系膜上动脉夹层被诊断出来,包括一些没有症状的肠系膜上动脉夹层。本病的病因及发病机制尚不明确,以往大部分文献报道多侧重于本病的诊断与治疗策略、效果,而对于本病的发病病因与发病机制并没有进行深入探讨。血流动力学的改变在主动脉夹层形成过程中起重要作用这一观点普遍被人们所接受,依据此点,我们尝试分析血流动力学改变与自发性孤立性肠系膜上动脉夹层的关系,而影响肠系膜上动脉内血流状态的主要因素是腹主动脉(abdominal aorta,AA)与肠系膜上动脉(superior mesenteric artery,SMA)之间的夹角,因此有必要对肠系膜上动脉夹角与自发性孤立性肠系膜上动脉夹层之间关系进行相关探讨。资料与方法回顾性分析2014年5月至2017年2月郑州大学第一附属医院腔内血管外科收治的35例SIDSMA患者的临床资料。其中男性33例,女性2例,年龄39-84岁,平均51岁,所有患者均经64排MSCTA明确诊断,并测量SMA夹角大小;收集35例正常成年人SMA夹角,比较SIDSMA患者与正常成年人的SMA夹角差别;测量SIDSMA破口位置至SMA开口处距离,对比其与SMA夹角的关系,并对结果进行探讨、分析。结果SIDSMA患者的SMA夹角大于正常成年人的SMA夹角(68.2±12.6°,55.8±17.8°,P0.05),差别有统计学意义,t=3.387,95%置信区间(5.129,19.850);SMA夹角与SIDSMA患病的OR值为1.054,95%置信区间(1.018,1.091)。SMA夹角在50°~80°之间时SIDSMA发病人数占总体的80%,其中60°~70°是所有组距段内发病人数最多的角度范围,占31.4%。在60°~70°之间时破口位置集中在20-30mm之间,而此区域是SMA移行区所在部位。结论SMA夹角与SIDSMA的发病有一定的相关性,SMA夹角在60°~70°时SIDSMA发病率可能更高;SIDSMA的发病可能受SMA夹角和SMA移行区的特殊解剖结构共同影响。
[Abstract]:Background and objective spontaneous isolated dissection of the superior mesenteric artery SIDSMA was once considered to be a rare disease, which was first reported by Bauersfeld in 1947. A growing number of spontaneous isolated superior mesenteric artery dissections, including asymptomatic superior mesenteric artery dissections, have been diagnosed. Most of the previous literature reports focused on the diagnosis and treatment of the disease, the results, However, the etiology and pathogenesis of the disease have not been thoroughly discussed. The idea that hemodynamic changes play an important role in the formation of aortic dissection is generally accepted. We tried to analyze the relationship between hemodynamic changes and spontaneous superior mesenteric artery dissection. The main factor affecting the blood flow status in superior mesenteric artery was the angle between abdominal aorta and superior mesenteric artery superior mesenteric artery (SAA) and superior mesenteric artery (SMA). Therefore, it is necessary to explore the relationship between the angle of superior mesenteric artery and spontaneous isolated superior mesenteric artery dissection. Data and methods retrospective analysis of the first affiliated hospital of Zhengzhou University from May 2014 to February 2017. Clinical data of 35 patients with SIDSMA treated by internal vascular surgery. Two female patients (39-84 years old, mean 51 years old) were diagnosed by 64 rows of MSCTA and the angle of SMA was measured, and 35 cases of normal adults were collected to compare the SMA angle between SIDSMA patients and normal adults. The distance between SIDSMA break position and SMA opening was measured, and the relation between SMA and SMA was compared, and the results were discussed. Results the SMA angle of SIDSMA patients was higher than that of normal adults (68.2 卤12.6 掳/ 55.8 卤17.8 掳/ p 0.05). The difference was statistically significant (P < 0.05). The difference between the SMA angle of SIDSMA patients and the incidence of SIDSMA was 1.05495% confidence interval 1.018181.091% and the incidence of SIDSMA was between 50 掳and 80 掳. 80, of which 60 掳to 70 掳was the angle range of the highest number of cases in all groups. Between 60 掳and 70 掳, the opening position is concentrated in the range of 20-30 mm, Conclusion there is a certain correlation between the SMA angle and the incidence of SIDSMA. The incidence of SIDSMA may be higher when the angle of SIDSMA is 60 掳to 70 掳. The incidence of SIDSMA may be affected by the SMA angle and the special anatomical structure of SMA transition area.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.2

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