维吾尔族与汉族咯血患者支气管动脉多层螺旋CT影像解剖学对比研究

目的 探讨维吾尔族与汉族咯血患者支气管动脉多层螺旋CT 血管成像(MSCTA)影像解剖学差异。方法 回顾性分析喀什地区第一人民医院2016年1月—2017年12月70例维吾尔族咯血患者(维吾尔族组)和70例汉族咯血患者(汉族组)行支气管动脉MSCTA检查,运用多平面重组(MPR)、最大密度投影(MIP)和三维容积重现(VR)等后处理技术显示和观察两组患者支气管动脉的起源、开口位置、分布类型、分型。结果 140例患者CTA显示支气管动脉共371支,其中原位208支(56.06%),异位163支(43.94%);其中70例维吾尔族患者原位支气管动脉占50.84%(90/177)、异位49.16%支(87/177),70例汉族患者原位支气管动脉占60.82%(118/194)、异位39.18%(76 /194),两组比较差异无统计学意义(χ²=3.740, P＞0.05)。两组患者异位支气管起源于主动脉弓、肋间动脉的占比比较差异有统计学意义(χ²=9.861、4.415, P值均＜0.05),原位支气管动脉开口位于降主动脉前、后、左、右侧壁位置组间比较差异有统计学意义(χ²=19.763, P＜0.01)。两组患者支气管动脉发育分型均以Ⅱ型多见,维吾尔族组患者占49.63%(66/133),汉族患者占55.64%(74/133),其次维吾尔族人以Ⅰ型(27.07%、36/133)和Ⅳ型(14.28%、19/133)多见,汉族以Ⅰ型(19.55%、26/133)和Ⅲ型(19.55%、26/133)为主,差异有统计学意义(χ²=12.766, P＜0.01)。结论 支气管动脉系统发育个体差异较大,维吾尔族与汉族咯血患者的支气管动脉起源、开口方位及分型,均存在一定的差异;在支气管动脉栓塞术前行支气管动脉CTA,可为介入治疗提供详尽的三维影像解剖信息,对快速选择责任血管,避免反复插管以缩短造影时间,均有一定指导意义。

Comparative study of bronchial artery anatomical multiple spiral between Uygur and Han races hemoptysis patients

Objective To explore the comparative study of the anatomical variation of bronchial artery system Uygur and Han races by muti-slice spiral CT angiography(CTA).Methods Retrospective analysis was performed on 70 cases of Uygur and 70 cases of Han patients with hemoptysis by MSCT from January 2016 to December 2017 in the First People's Hospital of Kashgar Region. The bronchial artery anatomical relationship of the bronchial artery in patients with hemoptysis was displayed and observed using post-processing techniques such as multi-plane recombination (MPR), maximum density projection (MIP) and three-dimensional volume reconstruction (VR).The origin, opening position, distribution type and typing of bronchial artery (BA) in two groups of hemoptysis patients were displayed and observed.Results A total of 371 bronchial arteries, 208(56.06%) in situ and 163(43.94%) in ectopic were observed in 140 patients with CTA.Among them, 70 cases of orthotopic bronchial arteries of Uygur showed a total of 90 branches, with ectopic 87/177(49.16%) branches, 70 cases of orthotopic bronchial arteries of Han showed 118 branches, with ectopic 76/194(39.18%) branches. There were no statistically significant differences between the two groups (χ²=3.740, P＞0.05). The heterotopic bronchial artery originated from the aortic arch and the intercostal artery was different between the two groups(χ²=9.861, 4.415, all P values＜0.05). There were statistically significant differences between the two groups in the location of the anterior, posterior, left and right walls of the descending aorta(χ²=19.763, P＜0.01). Type Ⅱ was also the most common type of bronchial artery development in both groups, with 66 branches in Uygur (49.63%, 66/133) and 74 branches in Han (55.64%, 74/133), followed by type Ⅰ (27.07%, 36/133) and type Ⅳ (14.28%, 19/133) in Uygur, and type Ⅰ (19.54%, 26/133) and type Ⅲ(19.54%, 26/133) in Han. There were significant differences between two groups(χ²=12.766, P＜0.01).Conclusions There are great differences between the Uygur and Han patients with hemoptysis in the origin of bronchial artery, location of wall opening and its developmental type. Bronchial artery CTA performed before bronchial artery embolization can provide detailed three-dimensional anatomical information for interventional therapy, which has great clinical significance for the rapid selection of responsible vessels and the avoidance of repeated intubation to shorten the angiography time.