急性DeBakey Ⅰ型主动脉夹层术后抗凝对残余假腔重塑效果的临床研究

发布时间：2018-04-27 09:51

本文选题：主动脉夹层 + DeBakey　；参考：《山东大学》2017年硕士论文

【摘要】：目的:利用影像学技术探讨急性DeBakey Ⅰ型主动脉夹层术前累及或者合并主动脉瓣病变对主动脉夹层胸腹主动脉远降段的病变严重程度的影响;主动脉夹层术后口服抗凝药物在短期内对急性DeBakey Ⅰ型主动脉夹层术后残余假腔重塑效果的影响,以及孙氏手术术后短期内腹主动脉直径的变化。资料与方法:回顾性收集2014年10月1日至2015年6月1日,收治的急性DeBakey Ⅰ型主动脉夹层病例31例。夹层的破裂口未累及主动脉瓣的患者20例,单纯行孙氏手术治疗;急性DeBakey Ⅰ型主动脉夹层的破裂口累及主动脉瓣且撕裂严重难以修复者11例,行孙氏手术+主动脉瓣置换术。收集患者术前的胸腹主动脉CT血管成像资料,以及外科手术后短期内(3-6个月)影像学复查资料两者相对比,分别测量在选取的6个不同断层平面术前、术后的真假腔直径,以及真腔直径与主动脉腔直径的比值,并评估假腔重塑情况,分析主动脉瓣置换术后短期内抗凝治疗对急性DeBakey Ⅰ型主动脉夹层残存假腔重塑效果的影响。结果急性DeBakey Ⅰ型主动脉夹层病例的影像资料中,未抗凝组术前与术后真腔直径和主动脉管腔直径的比值为:支架起始0.55±0.13 vs 0.94±0.11、支架中段 0.41±0.12 vs 0.86±0.19、支架末端 0.36±0.14 vs 0.71±0.22、腹腔干水平 0.39±0.15 vs 0.46±0.17、肠系膜上动脉水平 0.45±0.14 vs 0.40±0.14、肾动脉水平0.45±0.17 vs 0.47±0.14,在术中支架起始、中段、末端所在的3个主动脉CT测量平面术前及术后真腔内径与主动脉直径比值差异有明显意义(P0.01),在腹腔干、肠系膜上动脉、肾动脉3个断层平面术前及术后真腔内径与主动脉直径比值差异无明显统计学意义(P=0.20、0.21、0.61)。抗凝组术前与术后真腔内径和主动脉管腔内径的比值为:支架起始0.49±0.17 vs 0.81±0.27、支架中段 0.41±0.17 vs 0.75±0.20、支架末端 0.36±0.20 vs 0.62±0.21、腹腔干水平0.43 ± 0.14 vs 0.43 ±0.21、肠系膜上动脉水平0.40 ±0.14 vs 0.41±0.12、肾动脉水平0.40±0.16 vs 0.41 ±0.15,在术中支架起始、中段、末端所在的3个主动脉CT测量平面术前及术后真腔内径与主动脉直径比值差异有明显统计学意义(P0.01),在腹腔干断层平面、肠系膜上动脉断层平面、肾动脉断层平面真腔内径与主动脉直径比值差异无明显统计学意义(P=0.99、0.75、0.97)。据术前影像资料测得,未抗凝组与抗凝组真腔直径与主动脉管腔直径的比值为:支架起始 0.55±0.13 vs 0.49±0.17、支架中段 0.41 ±0.12 vs 0.41±0.17、支架末端 0.36±0.14 vs 0.36±0.20、腹腔干水平 0.39±0.15 vs 0.43±0.14、肠系膜上动脉水平0.41±0.14 vs 0.40±0.14、肾动脉水平0.45±0.17 vs 0.40±0.16,各断层平面真腔内径与主动脉内径的比值无明显差异(P=0.30、0.94、0.96、0.54、0.83、0.49)。急性DeBakeyⅠ型AD术后3-6个月,未抗凝组与抗凝组6个主动脉CT断层测量平面中真腔直径比主动脉管腔直径的比值为:支架起始 0.94±0.11 vs 0.81±0.27、支架中段 0.86±0.19 vs 0.75±0.20、支架末端 0.71±0.22 vs 0.62±0.21、腹腔干水平 0.46±0.17 vs 0.43±0.21、肠系膜上动脉水平0.45±0.14 vs 0.41±0.12、肾动脉水平0.47±0.14 vs 0.41±0.15,抗凝组与未抗凝组在上述断层平面中术后短期内真腔或支架内径与主动脉内径的比值差异无明显的差异(P分别为0.28、0.16、0.28、0.39、0.44、0.23)。结论:急性DeBakey Ⅰ型主动脉夹层术前破口是否累及主动脉瓣对主动脉夹层近端支架段及以胸腹主动脉动远降段的病变无明显影响;孙氏手术合并主动脉瓣置换术后早期内的抗凝治疗对DeBakey Ⅰ型主动脉夹层残余假腔的重塑效果无明显影响。
[Abstract]:Objective: To investigate the effect of acute DeBakey I aortic dissection before the operation of aortic dissection on the severity of the distal descending segment of the thoracic and abdominal aorta of aortic dissection, and the remolding of the residual false cavity after the aortic dissection after the aortic dissection in the short term after the operation of the aortic dissection. Effects and changes in the diameter of abdominal aorta after sun's operation. Data and methods: a retrospective collection of 31 cases of acute DeBakey type I aortic dissection from October 1, 2014 to June 1, 2015. 20 cases of aortic dissection without aortic valve rupture were treated with sun's operation; acute DeBakey I 11 cases of ruptured aortic dissection involving aortic valve rupture and severe tears are difficult to repair. Sun's surgery and aortic valve replacement are performed. CT angiography data of the thoracic and abdominal aorta before operation, and the short-term (3-6 months) imaging reexamination data after surgical operation are compared, and 6 different faults are measured respectively. The true and false diameter of the cavity before the operation, the ratio of the true cavity diameter to the diameter of the aorta, and the evaluation of the remodeling of the false cavity, the effect of the short-term anticoagulant therapy on the residual cavity remodeling of the acute DeBakey type I aortic dissection after the aortic valve replacement. Results the imaging information of the acute DeBakey type I aortic dissection The ratio of the diameter of the true cavity and the diameter of the aortic lumen in the unanticoagulant group was 0.55 + 0.13 vs 0.94 + 0.11, 0.41 + 0.12 vs 0.86 + 0.19 in the middle stent, 0.36 + 0.14 vs 0.71 + 0.22 at the end of the stent, and the celiac stem level 0.39 + 0.94 + vs At 0.45 + 0.17 vs 0.47 + 0.14, the difference in the ratio of the true cavity diameter to the aorta diameter was significant (P0.01) before and after the operation of the stent initiation, the middle and the end of the 3 aorta, and there was no difference in the ratio of the true cavity diameter to the aorta diameter before and after the 3 fault planes in the abdominal cavity, the superior mesenteric artery and the renal artery. The ratio of the inner diameter of the true cavity and the inner diameter of the aorta in the anticoagulant group was 0.49 + 0.17 vs 0.81 + 0.27, 0.41 + 0.17 vs 0.75 + 0.20 in the middle stent, 0.36 + 0.20 vs and 0.62 + 0.21 at the end of the stent, and the celiac stem level 0.43 + 0.81 + vs 14 vs 0.41 + 0.12, renal artery level 0.40 + 0.16 vs 0.41 + 0.15, in the operation of the stent initiation, the middle, and the end of the 3 aorta CT measured before and after the true cavity diameter and the aortic diameter ratio difference was significant (P0.01), in the abdominal dry fault plane, the superior mesenteric artery fault plane, the renal artery fault plane true There was no significant difference in the ratio of the diameter of the cavity to the diameter of the aorta (P=0.99,0.75,0.97). According to the preoperative image data, the ratio of the true cavity diameter to the diameter of the aorta in the anticoagulant group and the anticoagulant group was 0.55 + 0.13 vs 0.49 + 0.17, 0.41 + 0.12 vs 0.41 + 0.17 in the middle stent, and 0.36 + 0.14 vs 0.36 + 0.20 at the end of the stent. The level of the celiac trunk was 0.39 + 0.15 vs 0.43 + 0.14, the upper mesenteric artery level was 0.41 + 0.14 vs 0.40 + 0.14, the renal artery level was 0.45 + 0.17 vs 0.40 + 0.16, and the ratio of the inner diameter of the true cavity to the inner diameter of the aorta in each plane was not significantly different (P=0.30,0.94,0.96,0.54,0.83,0.49). The ratio of the true cavity diameter to the diameter of the aorta in the aortic CT fault measurement was 0.94 + 0.11 vs 0.81 + 0.27, 0.86 + 0.19 vs 0.75 + 0.20 in the middle segment of the stent, 0.71 + 0.22 vs and 0.62 + 0.21 at the end of the stent. 0.47 + 0.14 vs 0.41 + 0.15. There was no significant difference in the ratio of the true cavity or the inner diameter of the stent to the aortic diameter in the above fault plane in the anticoagulant group and the non anticoagulant group (P 0.28,0.16,0.28,0.39,0.44,0.23 respectively). Conclusion: whether the aortic valve of the acute DeBakey type I aortic dissection involves the involvement of the aortic valve to the aortic clamp The proximal end segment of the layer and the lesion of the distal descending segment of the thoracic and abdominal aorta had no obvious effect. The early anticoagulant therapy in sun's operation combined with aortic valve replacement had no significant effect on the remolding effect of the residual false cavities of DeBakey type I aortic dissection.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.3

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