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。     

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。     

基于CT血管成像在体子宫肌瘤动脉血管网数字化三维模型构建的方法及意义

目的 探讨利用CT血管成像原始数据集构建在体子宫肌瘤动脉血管网数字化三维模型的方法及意义. 方法 采用双源CTA技术获取1例子宫肌瘤患者的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、子宫肌瘤动脉血管网数字化三维模型并配准融合. 结果 构建的子宫肌瘤动脉血管网数字化三维模型可以...     

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。     

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。     

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.     

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.     

基于CT数据人离体胎盘血管网数字化三维模型重建研究

目的 探讨利用CT原始数据进行人离体胎盘血管网数字化三维模型重建的方法及应用。方法   选取2012年5月南方医科大学南方医院妇产科人正常妊娠足月离体胎盘20例,胎盘动脉灌注后进行增强CT扫描并获取DICOM原始数据集,随后行胎盘静脉灌注,胎盘标本再次行增强CT扫描,得到DICOM原始数据集。将两次数据导入Mimics 10.01软件分别重建得到胎盘动脉血管网及胎盘动静脉血管网的数字化三维模型。对CT扫描后的胎盘标本进行强酸腐蚀,得到胎盘血管铸型。对比同一胎盘标本的血管网数字化三维模型及血管铸型,明确数字化三维模型反映胎盘血管形态结构及走行的真实性和准确性。结果   基于CT原始数据,利用Mimics 10.01软件成功构建出胎盘血管网数字化三维模型。重建得到的模型立体感强,三维效果逼真,具有较佳的视觉效果,与胎盘血管铸型一致性高,可以清晰地再现胎盘动静脉各级血管分支的解剖形态结构,且可进行任意缩放、任意角度旋转观察。结论   基于CT原始数据构建的胎盘血管网数字化三维模型可全面、真实地展示胎盘血管,是一种胎盘血管研究的新方法;该模型的建立为后续研究提供了一定的三维重建的技术基础。     

数字化三维影像学与子宫肌瘤子宫动脉栓塞治疗

子宫肌瘤子宫动脉栓塞（UAE）治疗是通过栓塞肌瘤的动脉血管网而达到治疗的目的,因疗效确切、微创,深受要求保留子宫的肌瘤患者欢迎。但该术式仍有10%的患者效果不佳以及一定的并发症发生率。在术前筛选合适的病例、评估手术可行性及判断预后是进一步提高疗效、降低并发症发生的关键。传统的影像学手段不能达到上述目的,但应用数字化三维重建技术对患者的影像学原始数据集进行重建,可再现患者子宫及肌瘤的个体化血管解剖,为UAE的操作提供可视化动脉血管网模型,是解决上述关键问题的新兴手段。     

猪泌尿生殖系统动脉血管网模型的构建

目的研究构建猪泌尿生殖系统动脉血管网模型,为人子宫动脉血管网模型的构建提供技术基础。方法2008年3月至8月于南方医科大学南方医院妇产科获取雌猪离体泌尿生殖系统标本(子宫、附件、阴道、膀胱及尿道)3套,配置20%、15%、10%的过氯乙烯作为填充剂,分别经子宫动脉、卵巢动脉及尿生殖动脉灌注,采用酸腐蚀法,观察不同浓度填充剂构建的猪泌尿生殖系统动脉血管网显示的效果。结果(1)用20%过氯乙烯作填充剂构建的模型可清楚显示子宫动脉、卵巢动脉及尿生殖动脉主干的走行、分布及各动脉之间的吻合支,但细小动脉分支难以显示。(2)用15%过氯乙烯作填充剂构建的模型可进一步显示细小动脉的分支血管网。(3)用10%过氯乙烯作填充剂构建的模型可更清楚显示局部组织致密的血管网结构及交通支吻合情况。结论20%过氯乙烯作填充剂显示的血管网适合对模型进行计算机图像重建,采用15%过氯乙烯填充剂适于制作动脉血管网铸型标本,10%过氯乙烯作填充剂适于构建局部动脉血管网模型并进行特异性研究。     

基于增强CT连续扫描数据的胎盘植入患者产后盆腔结构三维模型的构建及意义

目的:探讨基于增强CT扫描数据重建产后女性在体盆腔结构三维模型的方法及意义。方法:选择1例阴道分娩后疑为胎盘植入产妇,经双源CT血管成像(CTA)技术扫描盆腔,将Dicom 3.0原始二维断层图像数据集导入Mimics软件,分别对骨盆、盆腔动静脉、输尿管进行三维重建并配准融合。结果:获取的在体胎盘植入患者产后盆腔结构数字化模型可以清楚显示骨盆、泌尿系统、髂总动静脉、髂外动静脉、髂内动静脉、子宫动脉及其分支,并可进行任意缩放和任意角度旋转,显示不同结构间的毗邻关系和空间构象,适于三维距离和角度测量。结论:利用CTA数据集,在Mimics软件下可方便快捷地建立理想的产后女性在体骨盆血管网的数字化三维模型,为妇产科医生更好地了解产后女性盆腔解剖结构、做好产后介入手术术前评估提供了理想的物理化模型平台。     

Impact of subserosal and intramural uterine fibroids that do not distort the endometrial cavity on the outcome of in vitro fertilization-intracytoplasmic sperm injection

Objective

To further evaluate the effects of intramural and subserosal uterine fibroids on the outcome of IVF-ET, when there is no compression of the endometrial cavity.

Design

Retrospective, matched-control study from January 2000 to October 2001.

Setting

Private IVF center.

Patient(s)

Two hundred forty-five women with subserosal and/or intramural fibroids that did not compress the uterine cavity (fibroid group) and 245 women with no evidence of fibroids anywhere in the uterus (control group).

Intervention(s)

In vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) cycles.

Main outcome measure(s)

The type of fibroid (intramural, subserosal), number, size (cm), and location of intramural leiomyomas (fundal, corpus) were recorded. Outcomes of IVF-ICSI cycles were compared between the two groups.

Result(s)

There was no correlation between location and number of uterine fibroids and the outcomes of IVF-ICSI. Patients with subserosal or intramural fibroids <4 cm had IVF-ICSI outcomes (pregnancy, implantation, and abortion rates) similar to those of controls. Patients with intramural fibroids >4.0 cm had lower pregnancy rates than patients with intramural fibroids ≤4.0 cm. There were no statistical differences related to delivery rates (31.5% vs. 32%, respectively) between all patients with fibroids and controls. Premature delivery rates for singleton gestations were 10% vs. 8%, respectively, in all patients with fibroid and controls.

Conclusion(s)

Patients having subserosal or intramural leiomyomas of <4 cm not encroaching on the uterine cavity have IVF-ICSI outcomes comparable to those of patients without such leiomyomas. Therefore, they might not require myomectomy before being scheduled for assisted reproduction cycles. However, we recommend caution for patients with fibroids >4 cm and that such patients be submitted to treatment before they are enrolled in IVF-ICSI cycles. Whether or not women with fibroids > 4 cm would benefit from fibroid treatment remains to be determined.     

Myoma pseudocapsule: A distinct endocrino-anatomical entity in gynecological surgery

Background.?The myoma pseudocapsule is a structure formed surrounding the uterine fibroid, that in the uterus separates the myoma from normal tissue; because literature is lack of detailed information concerning myoma pseudocapsule, the author reviewed this important topic.

Methods.?An extensive literature review from 1980 to 2008 was performed on the myoma pseudocapsule, using: fibroid, myoma, myomectomy and reproductive outcome, as keywords.

Results.?The fibroid removal should always be performed inside its pseudocapsule and with a careful stretching, to extract fibroid from the surrounding fibromuscular skeleton, breaking up the fibrous bridges; because the vascular network generally surrounds the myoma, detachment of the myoma occurring inside the pseudocapsule should cause less bleeding. The maintenance of myometrial integrity during myomectomy allows the facilitation of uterine healing and is of benefit for future reproductive outcome.

Conclusion.?The benefits of intracapsular myomectomy are evident, because it preserves myometrial integrity and allows for restoration of the uterine musculature. This correct myomectomy, if done by laparoscopy, confers significant advantages in less intraoperative blood loss, short duration of hospital stay, few therapeutic antibiotic administration and better future fertility.     

Uterine fibroid pseudocapsule studied by transmission electron microscopy

Objective

The fibroid pseudocapsule is a structure which surrounds the uterine fibroid, separates it from the uterine tissue and contains a vascular network rich in neurotransmitters like a neurovascular bundle. The authors examined the composition of the fibroid pseudocapsule using electron microscopy.

Study design

Twenty non-pregnant patients were submitted to laparoscopic myomectomy by the intracapsular method and samples of the removed pseudocapsules were analyzed using transmission electron microscopy.

Results

At the ultrastructural level the pseudocapsule cells have the features of smooth muscle cells similar to the myometrium. So, the pseudocapsules are part of the myometrium which compresses the leiomyoma.

Conclusion

This ultrastructural feature suggests that when removing fibroids their pseudocapsules should be preserved. This study confirms preliminary evidence that pseudocapsules contain neuropeptides together with their related fibers, as a neurovascular bundle. The surgeon's behavior should be directed to carefully control and spare this muscular surrounding tissue during fibroid excision, in order to preserve the myometrium as much as possible.     

子宫肌瘤子宫动脉栓塞术后妊娠情况及影响因素分析

目的:探讨子宫肌瘤患者行子宫动脉栓塞术(UAE)后的妊娠结局,以及肌瘤位置对妊娠率和结局的影响。方法:对行子宫动脉栓塞术的84例有生育要求和497例无生育要求的子宫肌瘤患者进行随访,了解其术后妊娠和产科并发症的发生情况。结果:(1)截止2011年4月,本研究中有50例患者60次妊娠。其中有妊娠要求组共30例39次妊娠,无妊娠要求组共20例21次妊娠。(2)有妊娠要求组妊娠结局为分娩26次(自然分娩9次,剖宫产17次),人工流产4次,自然流产5次,异位妊娠1次,宫内死胎3次(同1人);无妊娠要求组均行人工流产;(2)分娩的26例患者中,发现产科并发症7例26.92%(7/26),其中子痫前期1例3.85%(1/26)、胎盘前置状态1例3.85%(1/26)、早产4例15.38%(4/26)、中央性前置胎盘1例3.85%(1/26);(4)有妊娠要求的单发性肌瘤组(黏膜下、肌壁间、浆膜下、不明)和多发性肌瘤组的妊娠率分别为25.00%、59.09%、62.50%、14.29%和27.58%;单发浆膜下肌瘤组无产科并发症发生,黏膜下子宫肌瘤患者的产科并发症发生率高达75%。结论:子宫肌瘤患者在UAE后可正常妊娠,但自然流产率、胎盘异常等的发生率明显增高,特别是黏膜下和多发性子宫肌瘤患者。     

Menorrhagia after age 40. Contribution of ultrasonic examination

Menorrhagia after age 40 can have functional, general, local, or organic reasons. The most frequent are: submucous myomas, adenomyosis, polyps. Submucous myomas: a transvaginal scan (TVUS) specifies the type of myoma according to its situation within the uterine cavity: intracavitary myoma or submucous. A transvaginal scan is performed to assess myomas before operative HSC. There are three criteria to check: myomas diameter must be less than 5 cm; 5 mm or more of normal myometrium should be present between myoma and external wall; the myoma must not be in contiguity with a subserosal myoma. Uterine adenomyosis is a common gynecologic condition that is characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. Pathology may be proximal or distal, focal or diffuse. Transvaginal US shows: cystic dilatation of heterotopic glands, heterogeneity of the myometrial echotexture, antero-posterior asymmetry of the uterus. TVUS has a sensitivity of 62 to 89% and a specificity of 89 to 96%. Polyps are most often hyperechoic: this makes the diagnosis more difficult in luteal phase; Power Doppler shows the vascular central pedicle. TVUS has a sensitivity of 75%. The polyps smaller than 3 mm are not visible in a reliable way without the help of a contrast media in the cavity.