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。     

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。     

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...     

利用磁共振血管成像原始数据集构建在体女性骶前静脉丛数字化三维模型

目的:探讨利用磁共振血管成像(MRA)原始数据集及三维重建软件构建在体女性骶前静脉丛三维模型的方法,观察骶前区静脉解剖。方法:2012年10月于南方医科大学南方医院获取10名青年健康未育女性磁共振检查原始数据集,利用Mimics 10.0软件重建骶前静脉丛三维模型,以及骨盆、盆腔动脉三维模型。结果:构建出骶前血管网,其中骶横干静脉、骶正中静脉、骶外侧静脉可清楚显示,将其与骨盆、盆腔动脉三维模型配准融合,骶前静脉丛与动脉走行关系、骶前区无血管区域一目了然。结论:利用MRA原始数据集能够重建女性骶前静脉丛,为研究骶前血管提供一种方法,且具有较好的临床实用性。     

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。     

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.     

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。     

基于磁共振成像的在体女性骨盆数字化三维模型的构建

目的:探讨利用磁共振成像(MRI)原始数据集构建在体女性骨盆数字化三维模型的方法及意义。方法:对25例因各类妇科疾病在南方医科大学南方医院行盆腔MRI检查的患者,利用快速自旋回波T2加权(FSE-T2WI)序列对其行不压脂轴位高分辨薄层扫描,将采集的原始Dicom3.0数据集导入Mimics10.01软件中行骨盆三维重建及测量。结果:成功构建了在体女性骨盆的数字化三维模型,该模型解剖结构清晰、形态逼真、表面光滑,可以从任意角度观察骨盆的形态,并完成骨盆的三维测量。其中1例的数值如下:髂棘间径211.39mm,髂嵴间径236.31mm,骨盆入口前后径115.05mm,骨盆入口横径121.80mm,中骨盆横径106.10mm,坐骨结节间径114.96mm,耻骨弓角度93.7°。结论:基于MRI构建在体女性骨盆数字化三维模型是一种研究女性骨盆的新方法,具有立体感强、无辐射、可进行三维测量等优点,具有广阔的应用前景。     

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.     

基于磁共振成像在体盆腔及骶前区血管三维重建模型构建方法探讨

目的 探讨应用盆腔磁共振成像（MRI）原始数据重建在体女性骶前血管三维模型的方法及意义。方法 对2012年2-5月广州医科大学附属第一医院25例因盆腔良性肿瘤患者手术前行盆腔MRI检查,以e-THRIVE序列获取所有MRI原始数据,应用Minics10.0软件重建骶前血管三维图像。结果 骶前区血管三维重建均可清晰地显示腹主动脉、下腔静脉、双侧髂总、髂外及髂内动、静脉;25例患者中18例显示骶正中动脉,6例显示骶正中静脉及部分横干静脉。18例骶正中动脉均从腹主动脉分叉,平均直径为2.3(1.2～3.6) mm;6例骶正中静脉均汇入左侧髂总静脉,平均直径为3(1.7～4.6) mm。结论 利用e-THRIVE序列MRI扫描盆腔血管,可构建盆腔血管三维重建模型,且骶前区的骶正中动脉显影率高,部分病例可显影骶正中静脉及横干静脉。     

Common iliac artery flow velocity waveforms in fetuses with a single umbilical artery: a longitudinal study

Objective In fetuses with a single umbilical artery the entire blood flow to the placenta is transported through the common and internal iliac arteries from the side of the single artery, whereas the pelvic vessels from the side of the missing artery do not participate in the fetoplacental circulation. The aim of this study was to investigate the effect of gestational age on pelvic arterial blood flow in fetuses with single umbilical artery.
Design In 15 fetuses with a single umbilical artery (SUA), common iliac artery flow velocity waveforms were studied longitudinally using high resolution colour Doppler ultrasonography at three gestational ages: 18 to 20 weeks, 28 to 30 weeks, and 35 to 37 weeks. The pulsatility index was measured in each common iliac artery and mixed model analysis of variance was used to examine the effect of gestational age and side.
Results There was a highly significant difference in pulsatility index between common iliac arteries at all gestational ages, the values always being higher on the side that did not participate in the fetoplacental circulation (   P < 0.001  ). For increasing gestation, the pulsatility index fell significantly in the SUA side but remained high in the non-SUA side (   P < 0.001  ).
Conclusions This study shows that the asymmetry in the pelvic arterial blood flow in fetuses with SUA increases as pregnancy progresses, consistent with decreasing vascular resistance in the placenta and increasing resistance in the lower extremities.     

构建在体胎盘植入数字化三维模型在介入治疗中的应用

目的探讨构建数字化三维模型在胎盘植入患者行子宫动脉栓塞术(UAE)中的应用方法及意义。方法 2010年9月至2010年12月在南方医科大学南方医院将4例胎盘植入患者在UAE术前行双源CTA扫描,获取原始图像后利用Mimics10.01软件对其骨盆和动脉系统进行三维重建。将构建的胎盘植入数字化三维模型用于指导UAE操作并与数字减影血管造影(DSA)进行对比。结果胎盘植入数字化三维模型中1例患者的子宫动脉(2条)起源于髂内动脉,3例(6条)起源于臀下动脉,并可精确测量子宫动脉的起源角度、开口类型。胎盘的血供来源:3例来自双侧子宫动脉和卵巢动脉共同供血,1例仅由双侧子宫动脉供血,但该患者存在明显的子宫动脉卵巢支;血供的分布情况为3例双侧血供分布不均,以左侧为主,1例双侧供血均衡。除1例患者要求保守治疗外,其他3例均行UAE治疗并在术后顺利排出胎盘,术中DSA与重建结果对比,子宫动脉的起源和双侧血管的血供分布等均相同。结论构建的在体数字化三维模型对胎盘植入的介入治疗具有较大的术前和术中指导意义,可使手术过程更加精确化。     

Temperature gradients at various points within the human pelvis as measured during laparoscopy.

Temperatures have been measured during pelvic laparoscopy, under general anesthesia, in 59 women. Temperatures on the serosal surface of the rectum, the mesovarium, the ovarian arteries and the surface of the external iliac artery have been compared with the temperature deep in the rectal cavity on the rectal mucosa. The mean temperatures recorded at all sites within the pelvic cavity were lower than the mean temperatures recorded on the rectal mucosa. The mean differences between rectal mucosa and the other pelvic sites are: rectal mucosa -0.20 +/- standard error of the mean (SEM) 0.03C, mesovarium -0.28 +/-SEM 0.04C, ovarian artery -0.35 +/- SEM 0.05C and external iliac artery -0.44 +/- SEM 0.06C. All differences are highly significant from zero and do not appear to be related to the time from the onset of anesthesia, the temperature of the gas used to fill the abdominal cavity, the time from the last menustrual period and any pathology present in the pelvis. The results are consistent with a previous suggestion, by Grayson,2 that the human rectal mucosa may be an organ of heat production and that arterial blood within the pelvis may be precooled by counter current heat exchange with veins draining cold blood from the extremities.     

Effects of amrinone and dopamine on uterine blood flow and vascular responses in the gravid baboon

Amrinone is a bipyridine derivative with positive inotropic and vasodilator properties. We investigated its effects on uterine and iliac artery blood flow, blood pressure, and heart rate in 10 acutely instrumented gravid baboons. Amrinone was compared with dopamine, infused systemically or regionally via the common iliac artery. When given intravenously at a constant rate of 40 micrograms/kg/min, amrinone produced a slight increase in iliac artery blood flow but did not significantly alter mean arterial pressure, heart rate, or uterine artery blood flow. Dopamine at an intravenous dose of 40 micrograms/kg/min produced a mean (+/- SD) 49.2% +/- 18.7% increase in mean arterial pressure (p less than 0.01) and a 84.2% +/- 56.1% increase in uterine vascular resistance (p less than 0.01), but caused no changes in heart rate, uterine artery blood flow, or iliac artery blood flow. Regional infusion of amrinone at the rate of 25 micrograms/kg/min produced a significant increase in iliac artery blood flow (p less than 0.01) without changing uterine artery blood flow, heart rate, or mean arterial pressure. Regional infusion of dopamine at concentrations of 2.5 to 25 micrograms/kg/min produced decreases in flow (p less than 0.01) and increases in resistance (p less than 0.01) in the uterine and iliac vascular beds. We conclude that amrinone dilates the vascular bed of the external iliac artery, but has no remarkable effect on the uterine vascular bed. Dopamine increases uterine vascular resistance and may impair uteroplacental perfusion.     

Aberrant obturator vessels in minimally invasive pelvic lymph node dissection

The presence of aberrant obturator vessels, arising from the external iliac circulatory system and their lesion during a surgical intervention in the area, may lead to bleeding, which is difficult to control. For a period of 5 years, 133 endoscopic bilateral pelvic lymph node dissections in patients with cervical cancer were performed, and the present aberrant vessels were registered and filmed. Aberrant obturator vessels were present in 58 cases (43.6 %). Eight obturator arteries and 58 obturator veins, branches of the external iliac vascular system, were visualized. Arterial type of obturator variation was found in one (0.07 %) case, venous type—in 50 (37.5 %), and combined (arterial and venous) type—in seven (5.26 %), out of all patients. Of the observed aberrant obturator arteries, three were found to arise from the inferior epigastric artery, and five from the external iliac artery. Of all available 73 veins, 51 (70 %) drained directly into the external iliac vein and 22 (30 %) in the inferior epigastric vein. The frequency of the aberrant obturator veins was 27.44 % (n?=?73), and of the arteries—3 %, related to the investigated pelvic halves (n?=?266). The presence of aberrant obturator vessels is a relatively common anatomic variation, important for the clinical practice.