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目的探讨多层螺旋CT容积重组(VR)融合图像对支气管动脉开口冠状坐标定位在肺癌介入插管中的临床价值。资料与方法实验组选择26例肺癌经导管化疗的患者,术前行支气管动脉CTA检查,采用冠状坐标定位VR融合技术分别重组VR像,将动脉(含支气管动脉和主动脉)、肺癌肿块、气管、胸廓图像融合,获得一个三维的融合像,以气管分叉下缘为圆点建立坐标系,对支气管动脉开口进行冠状三维坐标定位,在介入术中根据开口定位结果进行插管;对照组选择19例未行支气管动脉开口定位的病例。两组病例从插管时间、对比剂用量、支气管动脉插管成功率进行对比分析。结果实验组通过VR融合图像进行支气管动脉开口定位,术中插管迅速,插管成功率100%,插管平均时间为(2.15±1.05)min,对比剂平均用量为(31.54±15.15)ml,多支供血者均分别进行灌注治疗;对照组插管平均时间为(20.74±8.09)min,对比剂平均用量为(80.00±13.33)ml,其插管平均时间明显延长,对比剂平均用量明显加大,插管成功率96%。将两组数据进行比较,差异有统计学意义(t值分别为9.95、11.36,P值均<0.01)。结论VR融合图像及其冠状坐标定位能直观显示支气管动脉的解剖特征,准确定位其开口位置,明显提高介入术中支气管动脉插管成功率,缩短照射时间,减少对比剂用量,提高治疗效果。
Objective To investigate the clinical value of multislice spiral CT volume reorganization (VR) fusion images in the coronary angiography of bronchial artery in the interventional intubation of lung cancer. Materials and Methods In the experimental group, 26 patients undergoing catheter chemotherapy for lung cancer were selected. The bronchial artery CTA was performed preoperatively and the VR images were retrospectively analyzed. Coronary arteries (including bronchial artery and aorta), lung cancer, trachea , Thoracic image fusion, to obtain a three-dimensional fusion of the tracheal bifurcation of the lower edge of the dot as a point to establish the coordinate system, the bronchial artery opening three-dimensional coronary positioning, interventional surgery according to the opening positioning results intubation; control group selection 19 cases of bronchial artery opening did not locate the case. Two groups of patients from the intubation time, contrast agent dosage, the success rate of bronchial artery intubation for comparative analysis. Results In the experimental group, the opening of bronchial artery was located by VR fusion images. The intraoperative intubation was rapid, the success rate of intubation was 100%, the average time of intubation was (2.15 ± 1.05) min, the average amount of contrast agent was (31.54 ± 15.15) ml, The mean duration of intubation in control group was (20.74 ± 8.09) min and that of contrast agent was (80.00 ± 13.33) ml, the mean duration of intubation was significantly longer, and the average amount of contrast medium was significantly increased Large, 96% success rate of intubation. The two groups of data were compared, the difference was statistically significant (t values were 9.95,11.36, P values were <0.01). Conclusions VR fusion images and coronary angiography can directly display the anatomical features of bronchial arteries and accurately locate the openings. The success rate of bronchial arterial cannulation is significantly improved, the irradiation time is shortened, the dosage of contrast medium is reduced and the therapeutic effect is improved.