锥型支架治疗慢性Stanford B型夹层术后主动脉重塑的形态学分析
发布时间：2019-03-02 19:44
【摘要】：目的：测量观察术前、术后主动脉不同平面真假腔几何参数,结合患者随访生存情况,使用锥型支架行腔内修复术(TEVAR)治疗慢性主动脉B型夹层的有效性,探讨术后主动脉形态学重塑的过程。材料与方法：纳入云南省昆明医科大学附属第一医院自2012年1月至2015年1月使用锥形支架行TEVAR术治疗的27例慢性Stanford B型主动脉夹层病人的CTA扫描图像后,选取主动脉峡部、降主动脉中端、降主动脉远端、腹腔干水平、肾动脉水平、及腹主动脉远端共6个平面,分别对主动脉、夹层真腔、夹层假腔的长径、短径、面积进行测量,计算真腔压缩指数(Ci)、真腔有效扩张面积(EEA)及有效扩张面积比(EER),分析术前术后6个平面上各项指标有无统计学差异,综合判定置入锥型人工覆膜支架后,主动脉各个层面的重塑效果,从而评判使用锥型支架行TEVAR术治疗慢性TBAD的有效性和可行性。结果：主动脉峡部水平面和降主动脉远端术后1月真腔短径较术前显著增加(P0.01)；主动脉峡部水平面和降主动脉中部术后1月假腔短径较术前明显减小(P0.01)；各水平面真腔面积术后1月均大于术前(P0.01)；主动脉峡部水平面、降主动脉中部及降主动脉远端水平面术后1月假腔面积小于术前(P0.01)；各测量水平面Ci值均升高(P0.05)；主动脉峡部、降主动脉中段及降主动脉远端EEA增加明显,而EER在各水平面均有不同程度升高。结论：使用锥型支架治疗慢性Stanford B型夹层术后覆膜支架主要覆盖区域(主动脉峡部、降主动脉中部、降主动脉远端)主动脉真腔通量变化显著,各个测量水平面主动脉形态学重塑效果良好；主动脉真腔面积在衡量TEVAR术后主动脉通量改变相较于测量真腔直径更为敏感。
[Abstract]:Objective: to measure and observe the geometric parameters of different plane true and false lumen of aorta before and after operation, and to evaluate the efficacy of (TEVAR) in treating chronic aortic dissection B with conic stent. Objective: to investigate the morphological remodeling of aorta after operation. Materials and methods: from January 2012 to January 2015, 27 patients with chronic Stanford B type aortic dissection treated with conic stent were enrolled in the first affiliated Hospital of Kunming Medical University, Yunnan Province. After CTA scanning, the aortic isthmus was selected. At the middle end of descending aorta, distal descending aorta, celiac trunk level, renal artery level and distal abdominal aorta, the length, short diameter and area of aorta, dissecting true cavity and dissecting false lumen were measured respectively. The true cavity compression index (Ci), the effective expansion area (EEA) and the effective expansion area ratio (EER), were calculated to determine whether there were statistical differences in the six planes before and after the operation, and after the placement of the cone-shaped artificial membrane-covered stent, the difference was statistically significant. To evaluate the effectiveness and feasibility of conic stent TEVAR in the treatment of chronic TBAD. Results: 1 month after operation, the horizontal level of aorta isthmus and the short true lumen diameter of descending aorta were significantly increased (P0.01), and the short diameter of false lumen at the level of aortic isthmus and the middle part of descending aorta 1 month after operation were significantly lower than those before operation (P0.01). 1 month after operation, the true cavity area of each horizontal plane was larger than that before operation (P0.01), and the false lumen area of aortic isthmus level, the middle of descending aorta and the distal horizontal plane of descending aorta was smaller than that of preoperative one month after operation (P0.01). Civalue of each measured level increased significantly (P0.05), and EEA increased significantly in aorta isthmus, middle descending aorta and distal descending aorta, while EER increased in different degrees at each horizontal level. Conclusion: after the treatment of chronic Stanford B dissecting with cone stents, the aortic true lumen flux changes significantly in the covered area (aortic isthmus, middle descending aorta, distal descending aorta). The morphological remodeling of horizontal aorta was better than that of normal control group (P < 0.05). Aortic true lumen area is more sensitive than true lumen diameter in measuring aortic flux after TEVAR.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.3
[Abstract]:Objective: to measure and observe the geometric parameters of different plane true and false lumen of aorta before and after operation, and to evaluate the efficacy of (TEVAR) in treating chronic aortic dissection B with conic stent. Objective: to investigate the morphological remodeling of aorta after operation. Materials and methods: from January 2012 to January 2015, 27 patients with chronic Stanford B type aortic dissection treated with conic stent were enrolled in the first affiliated Hospital of Kunming Medical University, Yunnan Province. After CTA scanning, the aortic isthmus was selected. At the middle end of descending aorta, distal descending aorta, celiac trunk level, renal artery level and distal abdominal aorta, the length, short diameter and area of aorta, dissecting true cavity and dissecting false lumen were measured respectively. The true cavity compression index (Ci), the effective expansion area (EEA) and the effective expansion area ratio (EER), were calculated to determine whether there were statistical differences in the six planes before and after the operation, and after the placement of the cone-shaped artificial membrane-covered stent, the difference was statistically significant. To evaluate the effectiveness and feasibility of conic stent TEVAR in the treatment of chronic TBAD. Results: 1 month after operation, the horizontal level of aorta isthmus and the short true lumen diameter of descending aorta were significantly increased (P0.01), and the short diameter of false lumen at the level of aortic isthmus and the middle part of descending aorta 1 month after operation were significantly lower than those before operation (P0.01). 1 month after operation, the true cavity area of each horizontal plane was larger than that before operation (P0.01), and the false lumen area of aortic isthmus level, the middle of descending aorta and the distal horizontal plane of descending aorta was smaller than that of preoperative one month after operation (P0.01). Civalue of each measured level increased significantly (P0.05), and EEA increased significantly in aorta isthmus, middle descending aorta and distal descending aorta, while EER increased in different degrees at each horizontal level. Conclusion: after the treatment of chronic Stanford B dissecting with cone stents, the aortic true lumen flux changes significantly in the covered area (aortic isthmus, middle descending aorta, distal descending aorta). The morphological remodeling of horizontal aorta was better than that of normal control group (P < 0.05). Aortic true lumen area is more sensitive than true lumen diameter in measuring aortic flux after TEVAR.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.3
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