腹主动脉瘤近端瘤颈及瘤体形态对EVAR围手术期的临床意义

发布时间：2018-05-10 13:34

本文选题：主动脉瘤 + 腹　；参考：《青岛大学》2015年硕士论文

【摘要】：目的:通过对已行腹主动脉瘤腔内修复术患者的影像学资料进行重建及测量,评估瘤颈、瘤体相关指标间的关系以及这些指标对临床疗效的影响,探讨近端瘤颈、瘤体形态在EVAR围手术期的意义。方法:收集2009年1月至2014年9月期间于我院诊疗并行腹主动脉瘤腔内修复术的患者的术前动脉CTA图像,应用Osirix影像处理软件对其进行二维及三维重建,并对近端瘤颈及瘤体相关指标进行测量和评估,通过住院病人病历检索系统检索患者围手术期临床资料,统计分析近端瘤颈及瘤体形态相关指标间的关系及其对EVAR术后疗效的影响。结果:近端瘤颈肾动脉下缘水平直径与颈体交界处直径呈中度正相关(r=0.744,P0.001),瘤腔最大直径与瘤体最大直径呈中度正相关(r=0.666,P0.001),瘤体直径与瘤体长度呈中度正相关(r=0.594,P0.001),近端瘤颈直径与瘤体最大直径呈低度正相关,近端瘤颈长度与瘤体长度呈中度负相关(r=-0.545,P0.001),而近端瘤颈长度与瘤体直径无明显相关性(r=-0.120,P=0.208)。近端瘤颈长度和成角以及瘤体直径和长度均可影响近端I型内漏的发生。结论:近端瘤颈直径在肾动脉下缘水平越大,则在颈体交界处也越大,但在选择支架型号及材料时需结合近端瘤颈整体形态构型;瘤体直径是影响近端瘤颈及瘤体形态其他指标的最重要因素,若瘤体直径越大,则近端瘤颈直径、瘤腔最大直径以及瘤体长度均越大,但瘤体直径与近端瘤颈长度无明显相关性。近端瘤颈及瘤体形态异常是影响近端I型内漏发生的重要因素,术前对AAA形态进行精确测量及评估,术中及时发现、积极处理,仍是近端I型内漏防治的关键所在。
[Abstract]:Objective: to evaluate the relationship between neck and tumor parameters and the effect of these parameters on the clinical efficacy of patients undergoing endovascular repair of abdominal aortic aneurysm by reconstructing and measuring the imaging data, and to explore the proximal aneurysm neck. The significance of tumor morphology in EVAR perioperative period. Methods: from January 2009 to September 2014, the preoperative arterial CTA images of patients treated in our hospital with endovascular repair of abdominal aortic aneurysms were collected and reconstructed by Osirix image processing software. The relative indexes of proximal neck and tumor were measured and evaluated, and the clinical data of patients during perioperative period were retrieved by the medical record retrieval system of inpatients. The relationship between proximal neck and tumor morphologic parameters and its effect on the curative effect after EVAR were analyzed statistically. Results: there was a moderate positive correlation between the horizontal diameter of the proximal carotid and renal artery and the diameter of the junction of the cervical body. The maximum diameter of the tumor cavity and the maximum diameter of the tumor were positively correlated with the maximum diameter of the tumor. There was a moderate positive correlation between the diameter of the tumor and the length of the tumor. The neck diameter was positively correlated with the maximum diameter of the tumor. There was a moderate negative correlation between the neck length of the proximal tumor and the length of the tumor body. However, there was no significant correlation between the neck length of the proximal tumor and the diameter of the tumor, and there was no significant correlation between the neck length of the proximal end tumor and the diameter of the tumor. The length and angle of the proximal neck and the diameter and length of the tumor can affect the occurrence of the proximal type I internal leakage. Conclusion: the larger the diameter of proximal neck is at the lower edge of renal artery, the greater is the size of the neck at the junction of the neck. However, the shape of proximal neck should be combined with the choice of stent type and material. The diameter of the tumor is the most important factor affecting the proximal neck and other parameters of tumor morphology. If the diameter of the tumor is larger, the diameter of the proximal neck, the maximum diameter of the tumor cavity and the length of the tumor are both larger. However, there was no significant correlation between the diameter of tumor and the length of proximal neck. The abnormal shape of proximal neck and tumor is an important factor that affects the occurrence of proximal type I internal leakage. The accurate measurement and evaluation of the shape of AAA before operation, the timely detection and active treatment during operation are still the key to the prevention and treatment of proximal type I internal leakage.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.3

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