320排CT在胸腹主动脉夹层术前诊断和术后评估中的应用

Application of 320-slice CT in preoperative and postoperative diagnosis of thoracoabdominal aortic dissection

目的:探讨320排CT在胸腹主动脉夹层术前诊断和术后评估中的临床价值。方法:收集东莞康华医院2015年5月—2017年5月经CT血管造影技术(CTA)确诊为主动脉夹层(AD)的26例患者,患者均行手术治疗采用日本东芝公司320排CT扫描仪检查,按照层间距及层厚0.625 mm对原始数据进行重建后经ADW4.4工作站分析,分别采用曲面重建(CPR)、多平面重建(MPR)、容积再现技术(VR)及最大密度投影(MIP)进行图像处理,原发破口位置以数字减影血管造影技术(DSA)检查结果为"金标准",CT检查结果与DSA检查结果进行对比并采取CTA进行随访。结果:320排CT检查共发现30个破口,其中阳性30个,阴性0个,准确率100.0%。4例A型破口选用全弓置换术+象鼻支架置入。22例B型患者行腔内隔绝术,其中4例左锁骨下动脉与破口距离<1.5 cm,18例>1.5 cm;4例左锁骨下动脉与破口距离<1.5 cm患者据CTA后处理对径线进行测量选择支架术后均吻合良好,其中1例破口位于3、5、6区,由于5区破口较小,出血较少,故于3、6区分别放置一枚支架,并予以密切随访、患者术后随访1~22个月,随访手段为CTA,随访期间死亡率为0。术后CTA随访显示重建主动脉弓及弓部血管的情况、血管内所在支架位置,与术中DSA吻合。3例显示左侧锁骨下动脉近段闭塞,原假腔血管内形成血栓,人工血管管腔通畅,位置正常;2例有内漏形成;3例残留胸腔积液或肺段不张,4例在腹主动脉残留假腔隙。结论:320排CT在胸腹主动脉夹层手术方案的制定及术后疗效的评估中均有重要价值。

Objective:To investigate the clinical value of 320-slice CT in preoperative and postop-erative evaluation of thoracoabdominal aortic dissection.Methods:26 AD patients confirmed by CTA from May 2015 to May 2017 in Kanghua Hospital were treated.320-slice CT scanner was used to reconstruct the original data according to the interval and thickness of 0.625mm.After data processing by ADW4.4 working station,the curved plannar reconstruction(CPR),multi-planar reconstruction(MPR),volume rendering tech-nique(VR)and maximum intensity projection(MIP)were used for image processing.In the original break loca-tion,DSA examination results were seen as“gold standard”.The examination results based on 320-slice CT and DSA(digital subtraction angiography)were compared;then patients were reviewed by CTA(computer to-mography angiography).Results:A total of 30 breaks were detected by 320-slice CT,including 30 posi-tive cases and 0 negative cases;the accuracy rate was 100%.4 cases with type A of breaks were treated with total arch replacement and elephant trunk stent.22 type B cases were treated with intravascular isolation,which 4 cases had the distance from left subclavian artery to the break<1.5 cm and 18 cases with the dis-tance>1.5cm.For 4 cases with the distance<1.5 cm,the fitting conditions of the chosen stents were fine through CTA processing.One case was focused in region 3,5,6;because of small breaks in region 5,the bleeding was not obvious;one stent was placed in region 3 and region 6,respectively.Patients were followed up for 1-22 months.During the process,the mortality rate was 0%,CTA examination indicated that the reconstruct-ed aortic arch and arch vessels and stent location were consistent with DSA examination results.3 cases had proximal occlusion in the left subclavian artery,and thrombosis in the original blood vessel prosthesis,normal blood flow in the artificial blood vessel and stent locations.2 cases had internal hemorrhage;3 cases of residual pleural effusion or atelectasis and 4 cases of residual false lacuna in the abdominal aorta.Conclusion:320-slice CT is of great importance in the planning and evaluation of surgical procedures for thoracoabdominal aortic dissection.