宫颈癌子宫动脉血管网三维模型的构建

目的 研究宫颈癌子宫动脉血管网的解剖学形态及血供分布情况.方法 2008年9月南方医科大学南方医院妇产科获取经病理证实的宫颈癌子宫、双附件及阴道标本一套,用15%的过氯乙烯填充剂经子宫动脉和卵巢动脉行分色灌注并铸型,观察宫颈癌子宫动脉血管网的解剖学形态及血供分配.结果 构建宫颈癌子宫动脉血管网模型具有子宫动脉血管网的基本形态特征,可清楚显示子宫动脉各主要分支、次级分支和细小血管网结构.宫颈癌癌灶部位血供丰富,血管形态紊乱,由双侧子宫动脉下行支供应,以患侧为主,但与对侧存在丰富的交通支,供血范围超过正常宫颈范围并包括部分阴道上段及左侧宫颈旁转移病灶;子宫动脉上行支近宫颈内口处的螺旋动脉通过交通支也参加部分供血.结论 应用血管铸型技术可成功构建宫颈癌子宫动脉血管网三维模型,通过模型可了解子宫动脉血管网及宫颈癌病灶的血供特点.     

人正常离体子宫动脉血管网三维模型的构建及意义

目的 研究人子宫动脉血管网表达的特点及意义.方法 2008年9月南方医科大学南方医院妇产科获取正常成年新鲜离体子宫、双附件及阴道一套,应用血管铸型技术构建人正常离体子宫动脉血管网模型,观察子宫动脉血管网的形态及血供分布情况.结果 (1)构建的人子宫动脉血管网模型可清楚显示子宫动脉及其各级分支的走行,表现在:①子宫动脉自主干依次分出膀胱支、输尿管支、上行支和下行支等分支动脉.②子宫动脉上行支沿途向宫体分出数条弓状动脉,在宫底部分出卵巢支、输卵菅支和宫底支,弓状动脉再发出若干螺旋动脉.(2)观察子宫动脉血管网模型发现:①子宫动脉存在明显的同侧供血倾向,双侧子宫动脉在子宫的中轴线处存在交通支,但较为细小.②子宫动脉上行支主要向宫体及双附件供血,而下行支主要向宫颈供血,较少向阴道供血.结论 采用血管铸型技术可构建理想的离体人子宫动脉血管网模型,为系统研究人子宫动脉血管网的解剖形态及血供分布提供了血管解剖学基础.     

在体女性盆腔动脉血管网数字化三维模型构建方法及意义

目的探讨构建在体女性盆腔动脉血管网数字化三维模型的方法及意义。方法基于双源CT血管成像(CTA)技术,获取1例子宫腺肌病患者的D icom 3.0原始二维断层图像数据集。利用M im ics10.01软件分别对骨盆、盆腔动脉血管网进行三维重建并配准融合。结果构建的在体女性盆腔动脉血管网数字化三维模型可以清楚地显示髂总动脉、髂外动脉、髂内动脉及其多级分支,甚至子宫动脉上行支等。与重建的骨盆配准融合后,各支动脉血管的解剖走行及供血范围变得更加清晰明确。结论基于CTA数据集,应用适当的计算机软件可构建出理想的在体女性盆腔动脉血管网数字化三维模型,为术前手术模拟真人化以及数字模型物理化提供了平台。     

子宫肌瘤动脉血管网数字化三维模型构建与特点

目的 利用基于CT血管成像（CTA）三维重建技术构建的子宫肌瘤动脉血管网数字化三维模型，探讨子宫与子宫肌瘤的血管网特点。方法 连续采集2012年1月至9月于南方医科大学南方医院接受CTA检查的72例子宫肌瘤患者的原始数据集，构建子宫肌瘤动脉血管网数字化三维模型，通过逐步调整阈值以改变模型的血管显示密度，并予透明化处理后作分析。结果 成功构建了72例患者的子宫肌瘤动脉血管网数字化三维模型，该模型可清晰的显示子宫动脉及子宫肌层、子宫肌瘤的血管网，可见肌壁间、浆膜下、黏膜下子宫肌瘤的血管网轮廓与子宫血管网的相对位置不同，其中浆膜下肌瘤轮廓显示最为清晰。重建模型中存在特殊类型的肌瘤血管网。结论 利用CTA和重建软件构建出的子宫肌瘤动脉血管网数字化三维模型形态逼真，可准确识别子宫肌层与子宫肌瘤的血管网，为术前评估和临床教学提供参考。     

子宫腺肌病子宫动脉血管网的构建与血供特点分析

目的利用基于CT血管成像(CTA)三维重建技术构建的子宫腺肌病子宫动脉血管网数字化三维模型,探讨子宫腺肌病血供特点。方法选取2009年9月至2016年7月在南方医科大学南方医院接受CTA检查的子宫腺肌病患者84例,采集其CTA原始数据集,构建子宫腺肌病子宫动脉血管网数字化三维模型,并通过调整阈值改变血管网显示密度,分析子宫腺肌病血供特点,即血供来源、血供类型、血流丰富程度等。结果 (1)本研究成功构建了84例子宫腺肌病子宫动脉血管网数字化三维模型,可清晰的呈现子宫动脉及子宫肌层、子宫腺肌病病灶的血管网,三维立体观察子宫腺肌病血供特点。(2)子宫腺肌病血供来源为双侧子宫动脉、双侧子宫动脉和一侧卵巢动脉、双侧子宫动脉和双侧卵巢动脉所占的比例分别为89.28%(75/84)、5.96%(5/84)、4.76%(4/84)。(3)子宫腺肌病血供类型为Ⅰ型(双侧子宫动脉供血为主型)、Ⅱ型(双侧子宫动脉供血均衡型)、Ⅲ型(一侧子宫动脉供血为主型)所占的比例分别为38.10%(32/84)、40.48%(34/84)、21.43%(18/84)。(4)子宫腺肌病血流丰富程度为富血流型、一般血流型、乏血流型所占的比例分别为69.05%(58/84)、20.24%(17/84)、10.71%(9/84)。结论利用CTA原始数据集和数字化三维重建技术可构建出子宫腺肌病子宫动脉血管网数字化三维模型,也可进行血供特点分析,为子宫动脉栓塞术的个体化应用和临床教学提供参考。     

子宫动脉血管网建模与子宫动脉栓塞术

子宫动脉栓塞术(UAE)是在子宫动脉血管内的手术.基于血管铸型技术构建的子宫动脉血管网模型成为我们研究子宫动脉血管网形态学的首个途径:它真实地显示了三维的子宫动脉及其血管网的解剖学特点,为UAE中如何正确操作避免部分并发症的发生并提高疗效提供了解剖学依据,也为进一步进行子宫动脉血管网的数字化研究奠定了基础.     

基于CT血管成像在体宫颈癌动脉血管网数字化三维模型的构建及意义

目的探讨利用CT血管成像(CTA)原始数据集构建在体宫颈癌动脉血管网数字化三维模型的方法及意义。方法 2010年5月在南方医科大学南方医院基于双源CTA技术,获取1例宫颈癌患者的CT-Dicom 3.0原始二维断层图像数据集。利用Mimics软件分别构建其骨盆、宫颈癌动脉血管网数字化三维模型并配准融合。结果构建的宫颈癌动脉血管网数字化三维模型不仅可以清楚地显示盆腔动脉血管网的各级分支,而且可多方位、多角度地观察各级动脉的管径、长度及分叉角度。此外,其还可进一步了解癌灶供血动脉及计算癌灶血容量。结论基于CTA数据集,应用计算机三维重建技术可构建出理想的宫颈癌动脉血管网数字化三维模型,为临床实现宫颈癌患者的个性化评估及治疗提供了平台。     

容积重建技术在产后盆腔动脉血管三维重建中的应用

目的:探讨容积重建技术(VRT)三维重建产后盆腔动脉血管的方法,评价其三维图像的质量.方法:6例阴道分娩后疑为胎盘植入的产妇,经双源CT血管成像(CTA)技术采集数据,利用VRT三维重建产后盆腔动脉血管网.结果:通过选择合适的参数,获得了良好的VRT立体图像.构建的6例患者血管图像均能观察到髂血管及其分支:髂总动脉6支;髂动脉分支11支(1支由于胎盘血管丛的遮挡不易观察而除外),其中髂外动脉、髂内动脉、臀上动脉及臀下动脉均可见;阴部内动脉10支;子宫动脉6支;闭孔动脉2支;髂腰动脉2支.结论:VRT构建的产后盆腔动脉血管三维图像清晰、立体感强,可以清楚显示盆腔血管的大部分分支.     

输卵管结扎术对卵巢功能的影响

<正> 输卵管结扎术(以下简称扎管术)是目前世界上最常用的女性绝育方法。但扎管术是否会影响卵巢功能,至今各家报道不一。近年来,用放射免疫分析法对扎管后妇女的卵巢激素水平进行测定,多数结果表明:扎管后有部分妇女卵巢功能受损,主要为雌、孕激素水平不足,术后有月经紊乱者更为明显。但也有一些报道与此相反。本文就这一问题的研究近况做一概述。一、扎管术可能导致卵巢血运改变输卵管、卵巢的血供均来自子宫动脉和卵巢动脉发出的输卵管支和卵巢支,其分支在输卵管系膜内相互吻合形成丰富的血管网,但两     

数字化三维重建技术与妇产科

【编者按】纵观数字医学的发展历史,其间经历了由平面显示到三维重建,由"只能看"到"还能动"的发展过程。虽然在妇产科领域的研究只有短短几年时间,但却成就斐然!其中以国际首报的人正常子宫动脉血管网数字化三维模型和人离体宫颈癌子宫动脉血管网数字化三维模型为代表,以此奠定了数字医学研究在妇产科应     

在体女性骶前静脉丛数字化三维模型构建方法及意义

目的探讨利用CT血管成像(CTA)原始数据集构建在体女性骶前静脉丛数字化三维模型的方法及意义。方法 2011年9月于南方医科大学南方医院获取1例宫颈癌患者的CTA原始数据集,利用Mimics10.01软件分别对骨盆、盆腔动脉血管网及静脉血管网进行三维重建并配准融合。结果构建出的盆腔静脉血管网数字化三维模型可清晰地显示下腔静脉、髂总静脉、髂内静脉、髂外静脉及其初级属支,骶前静脉丛亦清晰可见。与重建的骨盆、盆腔动脉血管网配准融合后,骶前静脉丛的解剖走形及引流区域变得更加清晰明了。尤为关键的是,骶前无血管区也可清晰显示。结论基于CTA的数字化三维重建技术是一种研究在体女性骶前静脉丛的好方法,可清晰显示骶前静脉丛及骶前的无血管区域,从而为阴道-骶骨固定术提供个体化的解剖学依据,并有效地降低手术并发症的发生率。     

Shunting the intervillous space: new concepts in human uteroplacental vascularization

OBJECTIVE: It is supposed that the intervillous space is not perfused by maternal blood during the first trimester, suggesting vascular shunts in the myometrium. We therefore attempted to provide arguments for a functional vascular anastomotic network located in the placental bed during human pregnancy. STUDY DESIGN: Three-dimensional (3D) sonography, laboratory analyses, and anatomic studies (hysterectomy specimens, uteroplacental vascular cast) were performed. RESULTS: Color Doppler showed a vascular network with anastomotic aspect located in the placental bed. A vascular cast of a uterus, obtained after postpartum hemorrhage, demonstrated a vascular anastomotic network in the myometrium. Higher PO2 levels in the uterine vein compared with the intervillous space confirmed the functional nature of this shunt. Low resistances in the uterine arteries during the first week after delivery suggested that this vascular network remains functional after placental expulsion. CONCLUSION: Our studies have yielded functional and anatomic evidence of an arteriovenous shunt located in the subplacental myometrium.     

A comparative study of intraplacental villous arteries by latex cast model in vitro and color Doppler flow imaging in vivo.

OBJECTIVE: The purpose of this study was to determine whether color Doppler sonogram can accurately depict the placental vascular structures using a latex cast model of the placental vessels, and to make a nomogram of several blood flow parameters according to the vascular structures. METHODS: First, we made 9 latex cast models of placental arteries and performed morphologic observation and measurement. Second, the comparative anatomical observation of placental vessels by color flow mapping was performed for all 9 patients from whom the latex models were made. Third, a total of 102 uncomplicated pregnant women between 18 and 40 weeks gestation were examined by color Doppler imaging. The resistance indices (RI) and peak systolic velocity (PSV) were measured. RESULTS: In the latex cast model of placentas, cotyledons could be differentiated by the presence of independent vascular structure units. First, second, third and fourth branches were noted in one cotyledon. Cotyledons were easily identified and counted by color Doppler imaging. Each cotyledon contained only one first branch of the intraplacental villous artery (IPVA). The number of IPVA-1 on color Doppler imaging was equal to the number of the cotyledon calculated from the latex model. RI exhibited a negative, and PSV a positive correlation with gestational age (p < 0.05 in both cases). At any given gestational age, both RI and PSV in the peripheral arteries were significantly lower (p < 0.01) than those in the upstream arteries. CONCLUSIONS: Color Doppler flow sonography is a valuable tool for detecting the blood flow of intraplacental villous arteries in vivo and the images agree with the vascular anatomy of placenta in vitro. These results may also provide the basic parameters for future studies of some complicated pregnancies.     

髂内动脉造影解剖研究及对血管内介入操作的指导意义

目的:探讨髂内动脉及子宫动脉造影解剖及其最佳投照体位,指导超选择盆腔血管插管,提高介入插管的准确率及成功率。方法:(1)分析71例正常成人腹主动脉及髂总动脉造影资料。测量双侧髂总动脉间的夹角、双侧髂内动脉开口的高度和髂总动脉长度;(2)观察髂内动脉及其分支正位、对侧斜位及同侧斜位显示状况;(3)总结髂内动脉及其分支的血管造影表现及其解剖类型。结果:(1)正常成年男性双侧髂总动脉间夹角均数为57.22°±8.39,°正常成年女性双侧髂总动脉夹角均数为66.41°±7.99,°男女均值间差异有统计学意义;右侧髂内动脉开口高于左侧,左侧髂总动脉干长于右侧;(2)对侧斜位投照较正位和同侧斜位投照能更好地显示髂内动脉及其分支的开口和行程;(3)依据正常成人髂内动脉造影表现及其主要分支(臀上、臀下及阴部内动脉)走行及分布,正常成人髂内动脉可分为4种解剖类型;(4)子宫动脉大部分发自髂内动脉前干,2.9%的子宫动脉升支发出明显的卵巢支。结论:(1)女性髂总动脉间夹角较大,经皮股动脉穿刺对侧髂动脉插管时宜采用直接插管技术,男性患者宜取成袢技术,能提高手术成功率和缩短插管时间;(2)对侧斜位有助于超选插管至髂内动脉及其分支;(3)盆腔血管内介入治疗的患者应根据其髂内动脉及其分支的解剖类型实行个体化介入手术操作。     

Transvaginal Doppler color flow mapping

Transvaginal Doppler color flow mapping was performed on 8 Japanese women (normal, 1; menopause, 2; uterine myoma, 1; endometriosis, 2; pregnant, 2). In all 8, bilateral uterine arteries and branches could be clearly identified in shades of blue and/or red. The color flows were abundant in the pregnant women. Transvaginal Doppler color flow mapping is expected to be an important diagnostic tool for assessing uterine arterial blood flows in physiologic and pathologic conditions of the pelvis.     

子宫动脉栓塞治疗妇产科良性疾病引起泌尿系统损伤的临床研究

目的探讨子宫动脉栓塞（uterine arterial embolization,UAE）治疗妇产科良性疾病引起泌尿系统损伤的原因、治疗及预防。方法对我院妇产科医学微创介入治疗中心收治的960例因妇产科良性疾病行UAE治疗患者的临床资料,进行回顾性分析,960例中,子宫肌瘤690例、子宫腺肌病244例、异位妊娠10例及产后出血16例。同时对损伤发生的血管解剖学、血管影像学及微导管的使用等问题进行分析总结。结果960例中,发生不同程度的泌尿系统损伤共5例,总发生率为0．5％（5／960）。其中中度损伤1例（0．1％）,为一侧输尿管节段性部分狭窄致肾积水;轻度损伤4例（0．4％）,为膀胱炎1例、膀胱黏膜部分坏死1例、一过性一侧肾轻度积水2例。5例中,子宫肌瘤4例、子宫腺肌病1例;5例均行双侧子宫动脉UAE术,术中均未使用微导管。行UAE引起泌尿系统损伤的原因,均为在栓塞动脉的过程中,栓塞剂进入子宫动脉中下段发出的输尿管支及膀胱支。结论对妇产科良性疾病进行UAE治疗,有发生泌尿系统损伤的危险;术中准确分辨血管及其分支、交通支,采用子宫动脉上行支进行栓塞,可以避免泌尿系统损伤的发生。     

Spiral (uteroplacental) arteries of the human placental bed show the presence of amniotic basement membrane antigens

The spiral arteries of the placental bed lose clearly recognizable arterial features early in pregnancy because of their invasion by extravillous trophoblast. Extensive structural alterations take place in the walls of invaded arteries, their walls containing an amorphous acidophilic "fibrinoid" matrix in which endovascular trophoblast is embedded. Such spiral arteries examined by immunofluorescence techniques in placental bed biopsy specimens obtained at cesarean section show a characteristic pattern of reaction with antisera to epithelial basement membrane amniotic antigens. These antisera have been previously demonstrated to react with the basement membrane of human amnion and of ectodermally derived epithelium such as breast ducts and skin. Interstitial trophoblast usually does not contain these antigens, and it is postulated that, following vascular invasion, endovascular trophoblast produces amniotic antigens to establish its presence. This may be of importance in maintaining the structural integrity of spiral arteries and thereby adequate maternal blood flow to the fetal-placental unit.     

Arteries of the uterine cervix in reproductive age in microangiographic studies

OBJECTIVES: The main aim of our research was the estimation of cervical arteries in women in the reproductive age. MATERIALS AND METHODS: Study was performed on 61 cases of organs taken, during autopsies, from the minor pelvis composing the female genital organs, urinary bladder, rectum and the upper part of the vagina from women aged 18 to 41. The material was divided in two groups: mothers and non mothers. The uterine arteries of a fresh specimen have been injected with radiological contrast medium Hexabrix 200 and Ultravist 370. The global X-rays of the organ complex and the microangiography of the uterine cervix were made. After that uterus was sectioned horizontally in sections of 4-5 mm thick and series of x-rays was performed. The number, size and way of uterine artery branches in the cervix were estimated. RESULTS: The cervical branches of the uterine artery were present in every cases. Usually branches were from 1 to 4 in number. All the branches were divided in cervical walls, very rich in upper and poorer in lower part of organ. Radiographic analysis revealed that connections between cervical vessels on both sides of the same uterus weren't permanent. Their absence was associated with the presence of the hypovascular or even avascular zone in the middle of the anterior and posterior cervical wall. CONCLUSION: The cervical branches of both uterine arteries are always present in the reproductive age, Number, size, course and way of cervical branches are different in all parts of the organ. The angioarchtectonic of cervical vessels does not depend on past pregnancies.