基于多层螺旋CT肺斜裂缺损和附属裂变异的观察

doi:10.3760/cma.j.cn101202-20200520-00166

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摘要目的探讨肺斜裂缺损及附属裂的变异情况。方法回顾性分析南京医科大学附属无锡第二医院2018年4—10月行胸部多层螺旋CT检查的1 450例受检者的影像学资料。男749例、女701例,年龄2~93岁,中位年龄46岁。利用多平面重建(MPR)技术将原始图像在横断面上进行重建,得到冠状面、矢状面图像。观察和分析肺斜裂的缺损情况,以及左侧水平裂、上副裂、下副裂、奇裂等常见附属裂的发生率及其他罕见附属裂变异情况。分类资料采用χ²检验,采用McNemar检验比较左、右两侧斜裂缺损的发生率的差异性。采用Spearman相关分析判断左右侧斜裂缺损程度、同侧斜裂缺损与附属裂之间的相关性。结果 1 450例受检者均存在双侧斜裂,未见斜裂缺失;271例(18.69%)左侧斜裂缺损、227例(15.65%)右侧斜裂缺损,其中95例(6.62%)存在双侧斜裂缺损。不同性别、不同年龄段的左侧或右侧斜裂缺损发生率比较,差异均无统计学意义(P值均＞0.05);1 450例受检者中左侧与右侧斜裂缺损发生率比较,差异有统计学意义(χ² = 6.003, P＜0.05),其中男性的左、右两侧斜裂缺损发生率差异有统计学意义(P值<0.01),而女性的左、右两侧斜裂缺损发生率差异无统计学意义(P值＞0.01)。左侧与右侧斜裂缺损程度呈正相关(r_s= 0.256,P＜0.01)。肺叶间裂出现附属裂变异者共有188例(12.97%),左侧水平裂、上副裂及下副裂的发生率分别为6.14%(89/1 450)、0.41%(6/1 450)、0.21%(3/1 450),右肺上副裂、下副裂及奇裂的发生率分别为5.38%(78/1 450)、2.14%(68/1 450)、0.28%(4/1 450),未见其他附属裂变异。有无左侧斜裂缺损者的左侧附属裂发生情况比较,差异有统计学意义(χ² = 6.250, P＜0.05);且左侧斜裂缺损程度与左侧有无附属裂呈负相关,但相关性较弱(r_s=-0.066, P＜0.05)。有无右侧斜裂缺损者的右侧附属裂发生情况比较,差异无统计学意义(χ²= 2.812, P＞0.05)。结论肺斜裂缺损和附属裂变异是常见的解剖变异,左侧斜裂缺损发生率高于右侧,左、右侧斜裂缺损程度呈正相关。

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	孙凯容
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关键词 ：肺, 肺斜裂, 体层摄影术, 螺旋计算机, 肺脏解剖变异

Abstract：Objective To investigate the incomplete oblique fissures and accessory fissures. Methods Retrospective assessment of multislice computed tomography(MSCT) examinations of 1 450 patients in Wuxi Second Hospital Affiliated to Nanjing Medical University from April to October 2018 was performed. There were 749 males and 701 females, aged 2-93 years old, median 46 years old. Coronal and sagittal images were reconstructed by multiplanar reformatting (MPR) on axial images. The incompleteness of oblique fissure and the incidence of common accessory fissures such as left horizontal fissure, superior accessory fissure, inferior accessory fissure, azygos fissure, and other rare accessory fissures were observed and analyzed. The classified data were tested by Chi-square test. The McNemar test was used to analyze the difference in the incidence of left and right incomplete oblique fissures. Spearman correlation analysis was used to judge the correlation of the incomplete degree of the left and right oblique fissures and the correlation between ipsilateral incomplete oblique fissure and accessory fissures. Results All of the 1 450 cases have bilateral oblique fissures with no oblique missing. The bilateral oblique fissures were incomplete in 95 cases (6.55%), the left oblique fissure was incomplete in 271 cases (18.69%), and the right oblique fissure was incomplete in 227 cases (15.65%). No statistically significant difference was observed in the incidence of the incompleteness of the left or right oblique fissure in different genders and different age groups (P＞0.05). However, a statistically significant difference was observed in the incidence of the incompleteness of the oblique fissure between the left and right sides in 1450 subjects. The difference in the incidence of the incompleteness of the left and right oblique fissure in men was statistically significant (P＜0.01), whereas that in women was not statistically significant (P＞0.01). A positive correlation was observed between the degree of the incompleteness of the left and right oblique fissure(r_s=0.256, P＜0.01). A total of 188 cases (12.97%) of accessory fissures were noted. The incidences of left horizontal fissure, superior accessory fissure, and inferior accessory fissure in the left lung were 6.14%(89/1 450), 0.41%(6/1 450), and 0.21%(3/1 450), respectively, and the incidences of superior accessory fissure, inferior accessory fissure, and azygos fissure in the right lung were 5.38%(78/1 450), 2.14%(68/1 450), and 0.28%(4/1 450), respectively. No other accessory fissure variations were observed. A statistically significant difference was noted in the incidence of left accessory fissure in patients with and without the incompleteness of the left oblique fissure (χ²=6.250, P＜0.05). A poor and negative correlation was observed between the incompleteness of the left oblique fissures and left accessory fissures (r_s=-0.066, P<0.05). No statistically significant difference was noted in the incidence of right accessory fissure in patients with and without the incompleteness of the right oblique fissure (χ²=2.812, P＞0.05). Conclusions The incompleteness of oblique fissures and accessory fissure variations are common anatomical variations. The incidence of the incomplete left oblique fissure is higher than that of the right side, and a positive correlation was observed between the degree of the incompleteness of the left and right oblique fissure.

Key words： Lung Oblique fissure of lung Tomography, spiral computed Lung anatomical variation

收稿日期: 2020-05-20

通讯作者: 张追阳,Email:zhangzhuiyang@163.com

引用本文:

孙凯容, 张追阳, 倪建明, 王圩健. 基于多层螺旋CT肺斜裂缺损和附属裂变异的观察[J]. 中华解剖与临床杂志, 2021, 26(2): 138-143.
Sun Kairong, Zhang Zhuiyang, Ni Jianming, Wang Weijian. Incomplete oblique fissures and accessory fissures of the lung observed by multislice computed tomography. Chinese Journal of Anatomy and Clinics, 2021, 26(2): 138-143.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20200520-00166 或 http://www.cjac.com.cn/CN/Y2021/V26/I2/138

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