卵巢动脉参与盆腔病变供血的介入诊疗研究

目的 观察卵巢动脉（OVA）参与盆腔疾病供血的出现频次，评价经导管栓塞OVA参与盆腔疾病供血的安全性。方法 用前瞻性方法对96例接受髂内-子宫动脉栓塞或化疗栓塞的患者进行了选择性OVA造影术，包括盆腔恶性肿瘤63例、子宫肌瘤17例、产科出血性疾病16例，平均年龄46岁。有盆腔手术史者12例。既往曾行髂内-子宫动脉栓塞术者6例。存在一侧或两侧子宫动脉发育不良者8例，两侧子宫动脉发育良好者（除去手术和已行栓塞治疗的患者）70例。对参与盆腔病变供血的OVA进行了选择。降栓塞术，观察OVA参与盆腔疾病供血的频次、影响因素，评价栓塞OVA的安全性和临床意义。结果 96例中，两侧OVA插管成功者58例（60.4％），一侧插管成功者38例（39．6％）。选择性造影发现至少有一侧OVA参与盆腔病变供血者33例（34．4％），包括盆腔恶性肿瘤18例、子宫肌瘤5例、产科出血性疾病10例。33例中有盆腔手术史者7例，曾行髂内-子宫动脉栓塞术者5例，存在一侧或两侧子宫动脉发育不良者8例，两侧子宫动脉发育良好者13例。OVA参与盆腔疾病供血的高发因素有：与孕产相关的出血性疾病（X^2=6．73，P=0．009）、既往有盆腔手术史（X^2=3．55，P=0．04）、既往曾行子宫动脉栓塞术（X^2=6，80，P=0．009）、存在一侧或两侧子宫动脉发育不良（X^2=3．40，P=0．04）。对33例参与盆腔供血的OVA进行了栓塞术，操作成功率为100％，无重要并发症。4例与产科相关的出血性疾病，曾行两侧髂内-子宫动脉栓塞后出血未止，经栓塞参与供血的OVA后出血立即停止。4例介入治疗后出现一过性卵巢功能减退症状。结论 OVA参与盆腔疾病供血的发生率达34％。在行髂内-子宫动脉栓塞或化疗栓塞术时，如发现OVA参与盆腔病变供血，补充OVA栓塞术是安全和有价值的。     

产后大出血：卵巢动脉造影和栓塞术的意义

目的:观察卵巢动脉(OA)作为产后出血来源的血管造影表现,评价经导管栓塞OA参与出血的安全性和疗效。材料和方法:对7例OA作为产后出血来源的患者进行了选择性OA造影和栓塞术。栓塞OA的材料有明胶海绵碎粒、PVA、微型钢丝圈。结果:选择性OA造影显示造影剂外溢至宫腔6例、OA直接参与子宫异常血管供血1例。补充栓塞参与出血或病变的OA后出血立即停止,住院期间未再复发出血,未发生与栓塞术相关的并发症。结论:OA可作为产后出血的主要供血动脉,是导致常规栓塞两侧髂内动脉-子宫动脉不能控制出血的原因之一。如发现OA参与产科出血性病变的供血,补充做OA栓塞术是安全和有效的。     

选择性动脉插管栓塞治疗子宫大出血的价值

目的 评价选择性动脉插管栓塞治疗子宫大出血的临床应用价值.资料与方法 对64例子宫大出血患者均行双侧髂总动脉数字减影血管造影(DSA)检查,明确出血部位后选择或超选择插管,栓塞子宫动脉或髂内动脉前干,栓塞剂采用明胶海绵、聚乙烯醇(PVA)微粒、弹簧钢圈.结果 64例患者行DSA检查时,盆腔区均可见对比剂外溢和聚集,其中36例采用明胶海绵颗粒栓塞子宫动脉或髂内动脉前干后31例止血一次成功,其中5例7～10天再发大出血,行第二次介入栓塞治疗后3例止血成功,仅2例止血效果不佳而行子宫切除术;20例采用PVA微粒和明胶海绵颗粒栓塞以及3例合并有动静脉瘘和2例合并有假性动脉瘤者采用明胶海绵条加弹簧钢圈后止血一次成功;3例采用PVA微粒和明胶海绵颗粒仅栓塞一侧子宫动脉或髂内动脉前干后3～7天再发出血,行第二次介人栓塞对侧子宫动脉或髂内动脉前干止血成功.介入术后随访2～6个月无复发,均有正常月经来潮,无严重并发症发生.结论 动脉栓塞治疗子宫大出血安全、止血迅速、微创,绝大多数能避免手术切除子宫.     

卵巢动脉造影及栓塞在妇产科疾病介入治疗中的意义

经导管作髂内动脉栓塞术是目前治疗盆腔肿瘤所致阴道大出血和产科大出血的首选方法 ,近年选择性子宫动脉栓塞术(UAE)已成为替代外科手术治疗子宫肌瘤的有效方法 .文献报道,无论是治疗妇产科大出血还是栓塞子宫肌瘤,髂内动脉-子宫动脉栓塞术有一定失败率(4%～19%),后者与盆腔内存在丰富的侧支循环有重要关系,其中卵巢动脉(OA)是主要的侧支血管之一.另外,OA与子宫动脉之间的吻合支是UAE术中误栓塞卵巢、导致闭经的原因.OVA开口变异发生率为2%～10%.正常OA直径＜1.1 mm,多不为腹主动脉造影所显示,但当存在子宫或盆腔病变、对血液供应需求增加时,OA可增粗.OA参与盆腔疾病供血的高发因素有子宫底部巨大肌瘤、有盆腔手术史、曾做过子宫动脉栓塞术、一侧或两侧子宫动脉发育不良.当存在前述情况时,将猪尾导管插至肾动脉水平做腹主动脉造影和选择性OA插管造影是必要的.一旦确认有OA参与病变供血,应考虑作超选择栓塞术,一般认为用直径＞500 μm栓塞剂是安全的.做OA近侧栓塞,尤其是联合两侧UAE,可能导致医源性卵巢功能不全.对于绝经前患者、又确有必要做OA栓塞时,应尽可能做单侧、接近病变处栓塞,术前应签署知情同意书.     

膈下动脉参与供血的肺部出血性疾病的诊断及介入治疗

目的观察膈下动脉（IPA）参与肺部出血性疾病病灶供血的表现，评价经导管栓塞IPA的安全性和疗效。方法回顾性分析18例IPA参与肺部病变供血的肺出血性疾病患者的临床和影像资料。患者中肺部恶性肿瘤9例、支气管扩张7例、慢性炎症2例；对参与肺部病变供血的IPA进行了选择性栓塞术，栓塞剂为聚乙烯醇微球（PVA）、明胶海绵颗粒和微型钢丝圈。结果选择性IPA造影均显示IPA管径增粗、分支增多紊乱和不同程度的新生血管形成，伴有肿瘤血管和肿瘤染色者9例、IPA供血区对比剂外溢6例、IPA与肺动静脉异常交通或分流9例、非特异性片状对比剂浓染2例。18例患者的病灶均与胸膜关系密切，病变贴近膈胸膜者11例、纵隔胸膜者5例、下肺外侧胸膜者2例。本组患者均行供血IPA的栓塞术，同时栓塞胸廓内动脉7例、肋间动脉3例，术后咯血停止；随访8个月至4年，3例分别于术后1、2、6个月复发少量咯血，经保守治疗后停止；15例未再咯血。结论IPA可参与肺部出血性病变的供血，以邻近横隔和纵隔胸膜的病变多见，这是造成支气管动脉栓塞术治疗咯血失败的原因之一，行供血IPA栓塞术安全有效。     

输尿管动脉栓塞在难治性产后出血介入治疗中的价值

目的 探讨输尿管动脉向子宫供血的特点及其在介入栓塞治疗难治性产后出血中的临床应用价值.资料与方法 回顾性分析3例难治性产后出血的盆腔侧支血管数字减影血管造影(DSA)表现及经动脉栓塞(TAE)止血情况.结果 3例患者均有输尿管动脉参与子宫供血,其中2例起源于髂外动脉,1例起源于子宫动脉和髂外动脉,将其栓塞后产后出血得到有效控制.结论 输尿管动脉是参与子宫供血的重要侧支血管;输尿管动脉参与子宫供血是单纯子宫动脉/髂内动脉栓塞后止血效果不佳的重要原因之一.     

髂内动脉栓塞治疗产后大出血

目的探讨髂内动脉栓塞治疗产后大出血的疗效与安全性。方法用弹簧圈或(和)明胶海绵对18例产后大出血患者行髂内动脉栓塞。栓塞后4～26个月,对5例患者用16排螺旋CT盆腔扫描并行动脉血管重建,8例患者行雌二醇(E2)、促卵泡激素(FSH)、黄体生成素(LH)、泌乳素(PRL)等激素检查。结果明胶海绵栓塞者栓塞远端动脉完全开放。钢圈加明胶海绵栓塞后可出现两种情况:一是子宫以卵巢动脉供血为主,部分开放的子宫动脉供血为辅;二是子宫仍以开放的子宫动脉供血为主。8例患者激素检查均为正常,2例再妊娠,未出现严重并发症。结论髂内动脉栓塞治疗产后大出血是安全有效的。     

The Efficacy of Gelatin Sponge in Treatment of Advanced Cervical Cancers with Hemorrhage

目的 探讨药物明胶海绵颗粒在中晚期宫颈癌合并出血中的应用价值.方法 23例中晚期宫颈癌患者,采用Seldinger经皮穿刺方法灌注双侧子宫动脉或髂内动脉前干,再用化疗药物中的一种细胞周期特异性药物与明胶海绵颗粒充分混合栓塞子宫动脉或髂内动脉前干.术后观察止血情况、肿块大小变化及与周围组织的边界情况.结果 (1)23例宫颈癌合并出血患者出血在术后2～3天均得到完全控制,总有效率100％;(2)原发灶经双侧子宫动脉灌注化疗及药物明胶海绵栓塞后,所有病例临床症状均有明显改善;(3)2例行1次介入治疗后肿块完全消失;7例在介入治疗后1个月改行妇科手术宫旁浸润得到明显改善;其余14例在行2～3次介入治疗后9例获得了二次妇科手术机会,术中出血少,肿块周边界限清晰,另外5例介入前分期在Ⅲb以上,尽管介入治疗次数达到了2～3次,局部肿块得到了一定控制,但周边淋巴结控制不明显.结论 对于中晚期宫颈癌合并出血患者,药物明胶海绵栓塞肿瘤的供血动脉治疗不仅可以起到直接阻断肿瘤血供,有利于出血部位止血,而且因明胶海绵的吸附作用,可以使药物长时间释放并作用于肿瘤细胞,达到双重治疗目的,不失为一种行之有效的治疗方法.     

支气管动脉栓塞术治疗支气管扩张大咯血失败原因之一:膈下动脉参与供血

目的观察膈下动脉(IPA)参与支气管扩张所致咯血供血的表现,评价经导管栓塞IPA的安全性和疗效。方法5年期间用经导管支气管动脉栓塞术(BAE)治疗支气管扩张所致大咯血62例,10例经选择性血管造影证实有IPA参与病变供血。对参与肺部病变供血的IPA进行选择性栓塞术,栓塞剂用明胶海绵颗粒8例、明胶海绵颗粒 微型钢丝圈2例。分析观察IPA参与肺部供血的表现、影响因素,评价栓塞IPA的安全性和临床意义。结果选择性IPA造影均显示IPA管径增粗、分支增多、紊乱和不同程度的新生血管,IPA供血区对比剂外溢4例、非特异性片状对比剂染色6例,IPA与肺动脉异常交通或分流者8例。10例患者病灶与胸膜关系密切:病变贴近膈胸膜和纵隔胸膜者6例、纵隔胸膜为主者4例。对10例患者均行供血IPA栓塞术,同时栓塞胸廓内动脉4例、肋间动脉2例,术后咯血停止。随访8个月～3年,2例分别于术后2、3个月复发少量咯血,经保守治疗后停止。8例未再咯血。结论IPA可参与支气管扩张症所致大咯血的供血,是造成BAE治疗咯血失败的原因之一。如发现IPA参与肺部病变供血,补充IPA栓塞术是安全和有价值的。     

大咯血的介入治疗及复发的影响因素分析

目的评价大咯血不同血供方式、栓塞方法的疗效及复发因素分析。方法120例大咯血患者行支气管动脉及临近体循环动脉造影,超选择性插管栓塞出血动脉。按供血方式分为单支动脉供血(35例)和多支动脉供血(85例)2组;按栓塞方法分为单纯明胶海绵栓塞(59例)、单纯PVA颗粒栓塞(20例)、PVA颗粒加明胶海绵栓塞(41例)3组,分别行χ2检验,评价各组的疗效。根据治疗效果分为复发(35例)与未复发(85例)为2组,对供血方式和不同栓塞方法进行分析,建立Logistic和Cox回归模型,评价各因素对复发的影响程度。结果120例患者行介入栓塞治疗后咯血均完全停止,技术成功率为100%。随访1～7年,35例复发,总有效率为70.8%。其中单支动脉供血4例复发,复发率11.4%;多支动脉供血31例复发,复发率36.5%。单纯明胶海绵组26例复发,复发率为44.1%;单纯PVA颗粒组3例复发,复发率为15.0%;PVA颗粒加明胶海绵组6例复发,复发率为14.6%。复发率差异有统计学意义(P<0.05)。单纯明胶海绵栓塞后复发时间最短(P<0.05);单纯PVA颗粒栓塞及PVA颗粒加明胶海绵栓塞复发时间较长,但两组之间差异无统计学意义(P>0.05)。结论单纯明胶海绵栓塞和多支动脉供血更容易导致介入栓塞治疗后复发且时间较短;单纯PVA、PVA加明胶海绵栓塞后疗效较好且复发间隔时间较长。     

Superselective pseudocontinuous arterial spin labeling

A new technique for the imaging of flow territories of individual extra‐ and intracranial arteries is presented. The method is based on balanced pseudocontinuous arterial spin labeling but employs additional time‐varying gradients in between the radiofrequency pulses of the long labeling train. The direction of the additional gradient vector is perpendicular to the selected artery and its azimuthal angle is switched after every radiofrequency pulse. The phases of the radiofrequency pulses are adopted to cancel out the phase accrual of the spins at the center of the target vessel due to the extra applied gradients. This results in efficient inversion at the targeted position, whereas elsewhere time‐varying phase changes will result in marginal inversion efficiency. By changing the moment of the added gradients, the size of the labeling focus can be adjusted. Influence of the temporal order of the additional gradients on the labeling efficiency and on the selectivity was investigated by simulations and experimental measurements. In a volunteer study, the acquisition of high signal‐to‐noise ratio flow territory images of small branches of the anterior cerebral artery distal to the circle of Willis was demonstrated. This shows the method's flexibility for dealing with complicated arterial geometries and its ability to superselectively label small intracranial arteries. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

中国人卵巢动脉的血管造影研究

目的观察国人卵巢动脉（OVA）的血管造影解剖,为选择性OVA插管治疗提供信息。资料与方法对138例进行了前瞻性OVA造影。96例（盆腔疾病组）因盆腔或妇科疾病行髂内动脉-子宫动脉化疗栓塞,42例（无盆腔疾病组）为无盆腔或妇科疾病患者。针对患者的原发疾病,按常规完成血管造影检查后行腹主动脉造影和选择性OVA造影,观察OVA的起源、走行、管径及参与盆腔疾病的供血情况。结果138例中,102例行两侧OVA选择性插管成功,96．1％的OVA发自腹主动脉前外侧壁,异位开口发生率占3．9％。两侧OVA开口在同一水平者占41．2％,左侧OVA开口高于右侧者占56．9％,右侧高于左侧者占2．0％。96．4％的OVA开口于L2椎体上缘至L3椎体下缘之间,98．6％开口低于肠系膜上动脉、98．2％低于肾动脉开口,左侧OVA开口高于肠系膜下动脉开口者占96．9％、右侧OVA开口高于肠系膜下动脉开口者占81．3％。在盆腔疾病组,至少有一侧OVA参与盆腔疾病供血者占34．4％。无盆腔疾病组OVA直径左侧为（0．9±0．3）mm（98．6％≤1．1mm）,右侧为（0．8±0．3）mm（95．6％≤1．1mm）;盆腔疾病组,左侧OVA直径为（1．7±0．6）mm,右侧直径为（1．8±0．8）mm;有盆腔疾病组与无盆腔疾病组之间的OVA直径差异有统计学意义（χ^2=75．29,P=0．00001）。结论卵巢动脉造影所见,包括其起源、开口与椎体的相对位置、管径及分支供血分布等,对介入治疗具有重要参考价值。     

“Complete-transposition-like” coronary arterial pattern in single ventricle with inverted infundibulum and transposition of the great arteries

In 19 out of 28 cases of single ventricle with inverted infundibulum and 1-transposition of the great arteries the right coronary artery arose from the posterior aortic sinus, the right anterior aortic sinus being the noncoronary one. This coronary arterial pattern was described before only in association with d-transposition of the great arteries. We suggest that angiocardiographic demonstration of this coronary arterial pattern in association with an 1-positioned aorta favors the diagnosis of single ventricle.     

Development of extrahepatic arterial blood supply to the liver during hepatic arterial infusion chemotherapy

The aim of this study was to evaluate the correlation of development of the collateral circulation to the liver during hepatic arterial infusion chemotherapy (HAIC) with the presence of hepatic tumours adjacent to the hepatic surface, and with pretreatment occlusion of aberrant hepatic arteries. In 102 patients with unresectable malignant hepatic tumours treated with HAIC using an implantable port system, development of collaterals to the liver was assessed with CT arteriography using the implantable port and pre- and postoperative angiography. Aberrant hepatic arteries, if present, were occluded prior to treatment for hepatic arterial redistribution. Collaterals to the liver were seen in 29 patients, who had 35 areas with collateral perfusion: 22 areas were in the right posterosuperior area, 6 in the left peripheral area and 7 in the right or left lobar area. Collaterals were revealed more frequently in patients with hepatic tumours adjacent to the hepatic surface than in those without hepatic tumours in peripheral areas in the liver (p < 0.0001). In addition, collaterals developed more frequently in patients with an aberrant hepatic arterial anatomy compared with those with conventional anatomy (p = 0.0007). Our results indicated that patients with hepatic tumours adjacent to the hepatic surface and with pretreatment occlusion of aberrant hepatic arteries had the potential to develop collaterals to the liver during HAIC. Received 4 November 1997; Revision received 24 February 1998; Accepted 2 June 1998     

Non-traumatic vascular emergencies: imaging and intervention in acute arterial conditions

Methods of imaging and intervention in acute non-traumatic vascular arterial conditions has changed substantially during recent years. Computed tomography, MRI angiography and, more recently, intravascular ultrasonography (IVUS) have replaced to a large extent conventional diagnostic angiography. An increasing number of patients are treated by endovascular interventions and numerous new treatment methods have been evaluated. Technical development of new equipment and instruments, increasing skill of interventional radiologists and better understanding of events following interventions improve continuously results of the treatment. Radiologic diagnosis and intervention have important roles in the treatment of acute non-traumatic vascular arterial conditions. Electronic Publication     

糖尿病足介入治疗17例回顾性分析

目的：评价糖尿病下肢动脉的血管改变及血管内介入治疗的临床价值。方法：对36例糖尿病足行下肢动脉DSA检查，并同时与血管超声进行对照。其中17例节段性狭窄行介入治疗(12例经皮血管球囊成形术，5例血管腔内支架植入)。术后常规抗凝治疗，并于6个月后血管造影复查。结果：糖尿病足下肢动脉有不同程度的狭窄与阻塞同时存在，细小动脉多有闭塞；17例行介入治疗者均有胭动脉以上动脉的慢性损伤。介入治疗可以改善糖尿病足下肢动脉的血液灌注，通过控制血糖和改善血液循环，其治疗的近期疗效令人满意。结论：DSA检查可以准确了解阻塞部位及程度，对糖尿病足的下肢动脉介入治疗疗效满意，可以大大降低患者的病残率。     

US, CT, and MR evaluation of accessory renal arteries and proximal renal arterial branches

RATIONALE AND OBJECTIVES: The purpose of this study was to compare color Doppler ultrasound (US), computed tomographic (CT) angiography, and magnetic resonance (MR) angiography for the evaluation of accessory renal arteries and proximal branches of the main renal artery. MATERIALS AND METHODS: Fifty-six subjects who had undergone conventional arteriography of the renal arteries participated in a prospective comparison of Doppler US (45 patients), CT angiography (52 patients), and nonenhanced MR angiography (28 patients). Conventional arteriography depicted 28 accessory renal arteries and 21 proximal branches of the main renal artery within 2 cm of the aorta. RESULTS: US depicted five of 24 accessory renal arteries seen at arteriography but no proximal arterial branches. CT angiography depicted 24 of 26 accessory renal arteries and 13 of 17 proximal arterial branches, as well as 15 additional accessory renal arteries not seen at conventional arteriography. MR demonstrated 11 of 15 accessory arteries, as well as four additional accessory arteries not seen at conventional arteriography. MR did not depict any of nine proximal arterial branches seen at conventional arteriography. CONCLUSION: When compared with US or nonenhanced MR angiography, CT is the preferred method for evaluation of accessory renal arteries and proximal branches of the renal artery.     

血管编码动脉自旋标记MR脑灌注成像初步研究

目的 初步应用血管编码动脉自旋标记MR脑灌注成像技术选择件标记双侧颈内动脉及后循环的血流分布区.方法 使用伪连续动脉自旋标记成像方法 对7名健康志愿者和6例脑血管病患者的左、右颈内动脉及椎基底动脉编码进行头部横断而成像和图像后处理,得到来源于上述不同血管的脑血流量(CBF)的灌注分布图,计算7名志愿者的双侧大脑厌、白质及半脑的CBF.比较脑血管病患者的血流分布结果 与DSA图像的一致性及低灌注区域与液体衰减反转恢复(FLAIR)T2WI的高信号区域大小.结果 定量测量正常志愿者的半CBF为(32.6±4.3)ml·min-1·100 g-1,脑白质血流最(10.8±0.9)ml·min-1·100 g-1,脑灰质血流量(55.6±2.9)ml·min-1·100 g-1.脑血管病患者的脑血流分布异常、侧支循环血流分布与DSA对应良好;所有患者低灌注区域比FLAIR T2WI显示的高信号区域范围更大.结论 血管编码动脉自旋标记MR脑灌注成像可以无创地定性并定量不同血管来源的脑血供.     

Treatment of a urinoma and a post-traumatic pseudoaneurysm using selective arterial embolization

We report a case of severe renal trauma giving rise to a pseudoaneurysm of a renal branch artery and a large urinoma secondary to fracture of a calix disconnected from the rest of the collecting system. Both conditions were successfully treated using selective arterial embolization.     

Sex and side differences of cerebral arterial caliber

Summary The diameter of 261 middle cerebral and 225 anterior cerebral arteries was measured on half axial antero-posterior (ap) view, and the diameter of 217 internal carotid arteries on side view angiograms. Mean diameter was significantly larger by 9.3%, 8.8% and 9.7% respectively in males than in females. In the females the vessels of the left hemisphere were wider but not significantly so than those of the right hemisphere, and the contrary was true for the males. In both sexes the side difference was reversed in the eighth decennium. There was no correlation of vessel diameter with age except for a statistically significant increase by 7.8% of right middle cerebral artery diameter in males from the fifth to the sixth decennium.