下腔静脉滤器置入术后倾斜和穿孔的CT随访结果

发布时间：2018-01-20 07:38

本文关键词： 下腔静脉滤器异常 CT　出处：《南京医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：多层螺旋CT （multi-slice spiral CT）评估下腔静脉滤器（inferior venacava filter，IVCF）置入后滤器倾斜和穿孔的临床价值。方法：本文收集了2011年1月至2012年10月获得CT随访资料的78例下腔静脉滤器植入术病例，回顾性评估滤器置入后随访期间发生滤器异常的CT表现，滤器置入的时间范围为1996年6月至2012年10月。78例患者中，女性45例（58％），男性33例（42％），平均年龄为38±9岁（16-75岁）。首次随访时间为滤器置入术后的12天-16年。CT增强扫描采用间接法、直接法MSCT血管成像,在后处理工作站进行多平面重建（multiplanar reformation, MPR）、容积再现（volume rendering,VR）、最大密度投影（maximum intensity projection, MIP）方法后处理。分别在CT冠状面、矢状面重建图像上测量滤器侧方及前后方向的倾斜角。下腔静脉穿孔程度的分级根据已公布的分级系统[3]：0级，滤器全部支撑杆均局限在下腔静脉管腔内；1级，支撑杆刚好要穿出但仍紧靠下腔静脉壁；2级，支撑杆完全在下腔静脉管腔以外；3级，滤器的支撑杆贴近或刺入邻近脏器或腹膜后结构。统计学处理采用SPSS11.5统计软件，比较下腔静脉滤器15度倾斜角在前后方向及侧方倾所占比例有无差异采用四格表的确切概率法计算， p0.05为差异有统计学意义。结果78例患者滤器置入时间为12天—16年，，滤器发生倾斜的共22例，17例倾斜角大于15°。滤器侧方倾斜的平均倾斜角为9°±2°，15例大于15°；前后方倾斜的平均倾斜角为10°±3°，10例大于15°；9例滤器仅表现在一个方向上倾斜角度大于15°；8例滤器双向倾斜角度均大于15°。滤器15°倾斜角在单纯侧方及前后方向所占比例无显著差异（p=0.5）。CT图像发现下腔静脉穿孔0-1级共71例，3-4级共7例，其中0级，68例，1级3例；2级3例；3级4例。结论多排螺旋CT能够较清晰地呈现下腔静脉滤器全貌并检测异常，可作为对滤器置入术后并发症及随访的有效方法。
[Abstract]:Objective: to evaluate the inferior venacava filter with multi-slice spiral CT. Clinical value of oblique and perforated filter after IVCFS implantation. Methods: 78 cases of inferior vena cava filter implantation were collected from January 2011 to October 2012. Ct findings of abnormal filters during follow-up were retrospectively evaluated. The time range of filter implantation was from June 1996 to October 2012 in 78 patients. There were 45 cases in females and 33 cases in males. The mean age was 38 卤9 years old and 16-75 years old. The first follow-up time was from 12 days to 16 years after the filter implantation. Ct enhanced scanning was indirect and direct MSCT angiography was performed. Multiplanar reconstruction was performed on a postprocessing workstation with multiplanar reformation, volume volume rendering. The maximum intensity projection (MIP) method was performed on the CT coronal plane. Sagittal reconstruction images measure the oblique angles of the side and front of the filter. Classification of perforation of inferior vena cava according to the published classification system [3] in grade 0, all the support rods of the filter were confined to the inferior vena cava; In grade 1, the support rod is just about to go through but still close to the inferior vena cava wall; Grade 2, the supporting rod is completely outside the inferior vena cava; In grade 3, the supporting rod of the filter was close to or punctured into the adjacent organ or retroperitoneal structure. SPSS11.5 software was used for statistical processing. To compare the difference of the gradient angle of 15 degrees of inferior vena cava filter in the front and back direction and the proportion of lateral tilting, the exact probability method of four grid table was used to calculate the difference. The difference was statistically significant (p0.05). Results the insertion time of filter was 12 days to 16 years in 78 patients. The tilting angle was more than 15 掳in 22 cases and the average angle was 9 掳卤2 掳in 17 cases. 15 cases were more than 15 掳; The average inclination angle of anterior and posterior tilting was 10 掳卤3 掳in 10 cases > 15 掳. In 9 cases, the filter was inclined more than 15 掳in one direction. The bidirectional tilting angle of filter was greater than 15 掳in 8 cases. Ct images revealed 0-1 grade inferior vena cava perforation in 71 cases. There were 7 cases of grade 3-4, of which 68 cases were grade 0 and 3 cases were grade 1. Grade 2: 3 cases; Grade 3: 4 cases. Conclusion Multi-slice spiral CT can clearly present the whole picture of inferior vena cava filter and can be used as an effective method for postoperative complications and follow-up.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.2

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