CT血管造影与X线透视融合技术在左心耳封堵术中的应用  

The application of the integration of CT angiography and X-ray fluoroscopy in the guidance of left atrial appendage closure

作　　者：赵诗垚 韩国栋 陶婷 孙守刚[1] ZHAO Shi-yao;HAN Guo-dong;TAO Ting;SUN Shou-gang(Department of Cardiology,the Second Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院(第二临床医学院)心血管内科,甘肃兰州730000

出　　处：《中国介入心脏病学杂志》2025年第3期150-154,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的 评估心脏CT血管造影(CTA)与X线透视融合技术在左心耳封堵术(LAAC中的应用。方法 本研究为前瞻性研究,纳入2022年1月至2023年8月于兰州大学第二医院行LAAC的患者82例,并根据是否接受图像融合进行1﹕1匹配。融合组(41例)为在CTA和X线透视融合技术支持下接受LAAC的患者;非融合组(41例)为在没有此技术支持的情况下接受了手术即传统手术方式的患者。记录两组的术中各项指标、围术期并发症及术后随访结局。结果 所有患者均成功封堵左心耳。融合组手术时间较非融合组明显缩短[(50.23±25.23)min比(65.71±29.15)min,P=0.012],差异有统计学意义。融合组与非融合组比较,显著降低了总辐射剂量[(195.15±205.59)mGy比(351.08±196.54)m Gy]、剂量面积乘积[(22.47±20.05)Gy·cm^(2)比(38.12±19.38)Gy·cm^(2)]和X线透视时间[(9.03±3.58)min比(13.35±4.23)min],与辐射剂量相对应,融合组的对比剂用量也相对减小[(59.32±24.65)ml比(93.12±35.08)ml],差异均有统计学意义(均P<0.001)。重复经间隔穿刺率有较明显差异(2.44%比12.20%,P=0.090),但差异无统计学意义;封堵器置入成功率(100.00%比100.00%)差异无统计学意义。两组患者随访45 d及6个月手术并发症发生率的比较,差异均无统计学意义(均P>0.05)。结论 CTA和X线透视融合技术在LAAC中是可行、安全和适用的。Objective To evaluate the effectiveness of CT angiography(CTA) imaging and fluoroscopic fusion navigation techniques in left atrial appendage closure(LAAC).Methods A total of 82 patients underwent LAAC in this prospective study and were matched(1:1) according to whether they underwent image fusion or not.The fusion group(41 cases) consisted of patients who received LAAC with the support of CTA and X-ray fluoroscopy fusion technology;The non fusion group(41cases) consisted of patients who underwent surgery using traditional surgical methods without the support of this technology.Record the intraoperative indicators,perioperative complications,and postoperative follow-up outcomes of both groups.Results The surgical time in the fusion group was significantly shorter than that in the non fusion group [(50.23±25.23) min vs.(65.71±29.15) min,P=0.012],The difference is statistically significant.Compared with the non fusion group,the fusion group significantly reduced the total radiation dose [(195.15±205.59) mGy vs.(351.08±196.54) mGy],dose area product[(22.47±20.05) Gy·cm~2 vs.(38.12±19.38) Gy·cm~2],and X-ray fluoroscopy time [(9.03±3.58) min vs.(13.35±4.23) min].Correspondingly to the radiation dose,the amount of contrast agent used in the fusion group was also relatively reduced [(59.32±24.65) ml vs.(93.12±35.08) ml],and the differences were statistically significant(all P<0.001).There was a significant difference in the rate of repeated interval puncture(2.44% vs.12.20%,P=0.090),but the difference was not statistically significant.Occluder implantation success rates were identical(100.00% vs.100.00%).No statistically significant differences in procedural complications were observed between the groups.Conclusions Three-dimensional CTA and fluoroscopic fusion navigation techniques are not only feasible and safe but also enhance the efficiency of LAAC procedures.

关 键 词：左心耳封堵术 CT血管造影 X线透视 图像融合 

分 类 号：R541[医药卫生—心血管疾病]