【作者】 唐震；

【导师】 刘朝晖；

【作者基本信息】 苏州大学 ， 人体解剖与组织胚胎学， 2018， 硕士

【摘要】 研究目的特发性肺纤维化(IPF)是一种原因不明,主要发生在老年,局限于肺部,组织病理学和影像学为慢性进行性致纤维化的间质性肺病。由于其自然病程不能逆转、现有的药物治疗不理想,该病患者预后较差。而肺移植手术是目前治疗终末期IPF的唯一有效手段。在肺移植治疗特发性肺纤维化的围手术期,患者胸部的相关组织器官(包括自体肺脏、肺动脉、主动脉、心脏、胸腔以及植入肺脏等等)发生着一系列变化,这些组织器官的内部结构、组织形态、大小位置、生理功能的改变和对移植状态下机体的调适能力,往往影响患者的疗效和预后。因此,只有准确了解、及时掌握肺移植患者围手术期相关组织器官的状况,才能有效地开展临床诊疗、改善患者预后。电子计算机断层扫描(Computer Tomoraphy,CT)尤其是高分辨CT(High-resolution,HRCT),具有无创便捷、检查时间短、空间分辨率和密度分辨高、显示人体解剖结构能力强等特点。本研究以CT为基本视角,对IPF患者肺移植手术前后胸部有关组织器官进行影像解剖学分析,旨在进一步了解IPF患者肺移植围手术期的胸部脏器结构功能变化,同时进一步了解CT对于诊断和评估该类患者的价值与作用。方法:2016年4月至2018年1月间,按标准遴选出接受肺移植手术治疗的特发性肺纤维化患者30例。在手术前后分别对30例患者进行胸部CT扫描检查,部分患者因病情需要还进行了肺动脉或冠状动脉CT血管造影(CTA)检查。运用影像工作站进行后处理重建和分析诊断,并测量肺动脉干、升主动脉、胸主动脉等直径、心脏左右径线以及胸廓横径。同时,测量患者手术前后肺动脉平均压。重点研究肺移植围手术期胸部CT影像解剖学表现,以及手术前后胸廓、心脏、肺动脉干等CT影像变化、肺动脉压变化和术后生存率情况。结果:1.术前胸部CT影像具有IPF肺部典型阳性征象(如:蜂窝改变、小叶间隔增厚、牵引性支气管扩张、网状线等等),且分布具有一定特点(主要分布于自胸膜下、肺基底部,并逐步发展至弥漫性肺内病变)。2.术后胸部CT影像呈现胸部手术后的非特异性阳性征象(需与临床、实验室检查结合)。3.肺动脉干直径与肺动脉压存在直线正相关,术后肺动脉压、肺动脉干直径均较术前变小。4、术后CT心胸比例、胸廓横径较术前变小。5、在本次研究中,单侧肺移植一年内生存率高于双侧肺移植。结论:1、CT对肺移植手术治疗IPF患者的明确诊断、术前评估、术后并发症以及预后判断等具有重要价值。2、对肺移植围手术期的IPF患者,CT不仅可以了解其移植肺工作状态,而且可通过手术前后影像解剖学直观对照,了解自体组织器官(未移植侧肺脏、肺动脉、心脏、胸廓等)解剖结构、功能运动状态。3、CT肺动脉干直径(MPAD)测量,有助于对IPF患者合并的肺动脉高压情况进行无创性评价,对患者诊疗具有价值。更多还原

【Abstract】 Objective:Idiopathic pulmonary fibrosis(IPF)is an interstitial pneumonia with unknown causes,mainly occurring in old age,confined to the lungs,histopathological andjor imaging causes of chronic progressive fibrosis.Because of the irreversible natural course of disease and the unsatisfactory drug treatment,the prognosis of the patient is poor.Lung transplantation is the only effective method for the treatment of IPF.In lung transplant treatment of idiopathic pulmonary fibrosis,perioperative patients with chest related organs(including autologous lung,pulmonary artery,the aorta,heart,chest and implanted into the lungs,etc.)with a series of changes,the internal structure of these tissues and organs,organizations,morphology,size,location,physiological function changes and to transplant the adjustment ability of the body,often affect the curative effect and prognosis of patients.Therefore,only by accurately understanding and timely mastering the status of relevant tissues and organs in perioperative period of lung transplantation patients can we effectively carry out clinical diagnosis and treatment and improve the prognosis of patients.Computer Tomography(CT),especially the high resolution CT(HRCT),has the features of non-invasive convenience,short inspection time,high spatial resolution and density resolution,and strong ability to display human anatomical structure.This study took CT as the basic perspective and conducted imaging anatomy analysis of the relevant tissues and organs of the chest before and after lung transplantation in IPF patients,aiming to further understand the changes in the structure and function of the chest organs in the perioperative period of lung transplantation in IPF patients and further understand the value and role of CT in diagnosing and evaluating such patients.Methods:30 patients with idiopathic pulmonary fibrosis received lung transplantation between April 2016 and January 2018.Chest CT scans were performed on 30 patients before and after the operation,and CT angiography(CTA)of pulmonary or coronary arteries was also performed on some patients because of their condition.The imaging station was used for postoperative reconstruction and analysis,and the diameters of pulmonary trunk,ascending aorta,thoracic aorta,left and right cardiac diameter and thoracic transverse diameter were measured.The mean pulmonary artery pressure before and after operation was measured.The anatomy of chest CT images before and after surgery,the correlation between pulmonary trunk and pulmonary artery pressure,the changes in the diameter of large blood vessels such as CT cardiothoracic ratio,thorax,heart and pulmonary trunk before and after surgery,and the survival rate after surgery were mainly studied.Results:1.Preoperative chest CT images showed typical positive signs of IPF lung(e.g.,honeycomb changes,thickening of interlobular septum,traction bronchiectasis,reticular line,etc.),and distribution had certain characteristics(distributed in the progressive development of diffuse intrapulmonary diseases from the subpleural and basal parts of the lung).2.Postoperative chest CT images showed non-specific positive signs after chest surgery,which should be combined with clinical and laboratory tests.3.There was positive correlation between pulmonary arterial stem diameter and pulmonary arterial pressure.Both pulmonary arterial pressure and pulmonary arterial stem diameter were smaller after operation than before operation.4.Postoperative CT cardiothoracic ratio and thoracic transverse diameter were smaller than those before surgery.5.In this study,the one-year survival rate of unilateral lung transplantation was higher than that of bilateral lung transplantation.Conclusion:1.CT is of great value in the clear diagnosis,preoperative evaluation,postoperative complications and prognosis of IPF patients treated by lung transplantation.2.For IPF patients in the perioperative period of lung transplantation,CT can not only understand the working status of lung transplantation,but also understand the fimctional and motor status of autologous tissues and organs(untransplanted lateral lung,pulmonary artery,heart,thoracic,etc.)through visual comparison of image anatomy before and after surgery.3.CT pulmonary arterial stem diameter measurement is helpful for noninvasive evaluation of pulmonary hypertension in IPF patients.更多还原