成人正常主动脉的形态特点

发布时间：2018-05-09 05:54

本文选题：升主动脉 + 主动脉弓　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:本课题通过血管影像工作站对主动脉CT血管造影(CTA)进行观察,并对主动脉及弓上分支血管进行一系列测量,进而了解升主动脉、主动脉弓以及弓上分支的解剖形态学特征,为升主动脉及主动脉弓部的腔内移植物的设计、介入治疗技术的发展建立解剖形态学基础。方法:按排除标准收集2016年1月~12月在我院进行CTA检查的患者240例,使用AW4.6工作站对CT图像进行多种后处理,获得主动脉及主动脉弓上分支血管的三维图像,按弓上分支类型将主动脉弓分为正常型和变异型,对187例正常型主动脉及弓上分支血管的直径、长度、角度及距离进行测量。使用SPSS22.0统计学软件分析获得的数据。结果与分析:一、正常型主动脉的测量与分析:1、主动脉弓的分型结果:(1)240例病人中,正常型共187例,占77.92%,男性正常型出现率为79.22%,女性正常型出现率为75.58%,在性别上差异无统计学意义(P0.05);变异型共53例,BCT与LCCA共干型31例,占58.50%,LVA直接发自主动脉弓型21例,占39.62%,BCT与LCCA共干合并LVA直接发自主动脉弓型1例,占1.88%。(2)187例正常型主动脉中I型弓93例,II型弓82例,III型弓12例,各型主动脉弓在各年龄段的分布不全相同,差异有统计学意义(P0.05)2、正常型主动脉的测量结果(均值±标准差):(1)主动脉直径:冠状动脉(CA)开口以远20mm处D1(32.74±4.52)mm,CA开口以远40mm处D2(34.17±4.90)mm,主动脉弓近端D3(32.11±4.11)mm,头臂干(BCT)与左颈总动脉(LCCA)之间D4(30.23±3.95)mm,LCCA与左锁骨下动脉(LSA)之间D5(28.16±3.30)mm,LSA以远20mm处D6(26.27±3.35)mm;(2)主动脉长度:CA开口至BCT开口L1(72.70±12.80)mm,CA开口至LCCA开口L2(87.19±14.02)mm,CA开口至LSA开口L3(103.48±17.17)mm;(3)主动脉角度:升主动脉弯曲角度(37)(111.69±14.25)°,主动脉弓与矢状面夹角q(23.83±6.31)°。3、主动脉参数的统计分析:(1)D6、L2、L3男性大于女性,差异存在统计学意义(P0.05),其余测量数据男女分组间差异均无统计学意义。(2)在19~40岁,41~60岁,61岁以上三个年龄组中,D1~D6、L2、L3均随着年龄的增长而增大,差异存在统计学意义(P0.05);在41~60岁、61岁以上两组中,L1均大于19~40岁年龄组,而Φ均小于19-40岁年龄组,差异存在统计学意义(P0.05);在19~40岁、41~60岁两组中θ均大于61岁以上年龄组,差异存在统计学意义(P0.05)。其余变量年龄分层间差异无统计学意义。二、正常型主动脉弓上分支的测量与分析:1、主动脉弓上分支的测量结果(均数±标准差):(1)弓上分支血管直径:BCT开口及开口以远20mm处d1(15.31±2.37)mm、d2(12.45±2.09)mm,LCCA开口及开口以远20mm处d3(11.86±2.19)mm、d4(7.70±1.19)mm,LSA开口及开口以远20mm处d5(13.62±1.94)mm、d6(9.36±1.37)mm;(2)弓上分支血管长度和距离:BCT开口至右锁骨下动脉(RSA)起始处L4(37.77±9.18)mm,LSA至左椎动脉(LVA)起始处L5(42.78±11.75)mm,BCT-LCCA间距S1(4.04±2.59)mm,LCCA-LSA间距S2(8.71±4.35)mm;(3)弓上分支与弓主干夹角:BCT、LCCA、LSA与弓成角分别为α(29.54±12.89)°、β(40.57±16.91)°、γ(58.48±21.80)°;(4)I型主动脉弓上分支间相对位置参数:三分支夹角λ(144.44±9.74)°,LCCA中心距BCT-LSA中心连线的距离R(4.60±1.21)mm。2、弓上分支参数的统计分析:(1)d3、d4、d5、d6、L4、L5、S2均男性大于女性,差异存在统计学意义(P0.05),其余弓上三分支参数男女分组间差异无统计学意义。(2)在19~40岁、41~60岁、61岁上三个年龄组中,d1、d2、d4均随着年龄的增长而增大,而α、γ均随着年龄的增长而减小,差异存在统计学意义(P0.05);在41~60岁、61岁以上两组中,d3、d5、d6、S2、R均大于19~40岁年龄组,而λ小于19~40岁年龄组,差异存在统计学意义(P0.05);在19~40、41~60岁年龄组中,L4、L5均小于61岁以上年龄组,差异存在统计学意义(P0.05)。其余变量年龄分层间差异无统计学意义。通过对187例正常型主动脉的测量,获得了较为详细的升主动脉、主动脉弓以及弓上分支的形态学参数,并且通过性别、年龄分层进行统计学分析发现主动脉形态变化的一些规律,具有重要的临床意义。以上这些参数还可为新型腔内移植物、人工血管的设计制作提供详细的参考信息。
[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.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R322.1;R654

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