分析子宫动脉起源及开口情况对

目的 对子宫动脉起源及开口情况进行分析,提高栓塞治疗子宫肌瘤的成功率.资料与方法 71例子宫肌瘤患者进行双侧髂内及子宫动脉造影,观察子宫动脉起源及开口情况,并比较用不同投照角度造影对子宫动脉的显示情况.结果 40.8%子宫动脉起源于臀下阴部干;29.6%源于臀下动脉;18.3%源于阴部内动脉,8.5%源于脐动脉,2.8%髂内动脉主干.47.3%子宫动脉在正位造影显示较好,86.2%子宫动脉在10°～30°右斜位造影或10°～30°左斜位造影显示较好.结论 多数患者子宫动脉发自髂内动脉分支;斜位造影显示子宫动脉优于正位造影.     

盆腔动脉造影正位与斜位对子宫动脉开口显示的比较

目的　探讨子宫动脉开口显示的最佳位置 ,指导医生超选择子宫动脉插管。资料与方法　回顾性分析84例髂动脉血管造影的结果 ,采用正位、同侧斜位和对侧斜位血管造影 ,以及采用不同角度的同侧斜位造影 (将斜位造影分为 16°～ 30°,31°～ 4 5° ,4 6°～ 6 0°三组 ) ,对子宫动脉开口显示结果进行对比 ,选择出显示子宫动脉开口的最佳位置与角度。结果　 (1)正位、同侧斜位和对侧斜位对子宫动脉开口的显示率分别为 6 %、6 5 .4 %和 12 .5 %(χ2 =2 8.12 ,P <0 .0 1)。 (2 )同侧斜位 16°～ 30°、31°～ 4 5°和 4 6°～ 6 0°对子宫动脉开口的显示率分别为 2 5 %、85 .7%和75 %。结论　髂动脉造影显示子宫动脉开口的最佳位置为同侧斜位 ;最佳倾斜角度为 31°～ 4 5°。     

子宫动脉栓塞术对子宫肌瘤、子宫腺肌症治疗若干问题初探

目的 :子宫动脉栓塞术对子宫肌瘤、子宫腺肌症若干问题进行初步探讨。方法 :对 2 8例正常的女性盆腔血管造影进行子宫动脉的分析。对 14例子宫肌瘤、子宫腺肌症的子宫动脉栓塞治疗方法进行前瞻性分析 ,术前均行B超引导下病灶穿刺活检。结果 :正位投照子宫动脉开口显示仅 9.4% ,子宫动脉开口主要被臀上动脉掩盖为 86 .2 1% ;子宫动脉开口显示在左、右前斜位 2 5°～ 30°头侧倾斜 15°对子宫动脉显露最为理想。术前B超诊断与病理诊断符合率肌瘤组 ( 10 /11) 91%、腺肌症组 3例均符合。单侧的子宫动脉卵巢支栓塞 ,术后性激素变化未见异常 ,月经正常来潮卵巢功能未见受损。结论 :栓塞治疗子宫肌瘤和子宫腺肌症中对组织活检病理检查利于客观及科学的评价 ;左右前斜位 2 5°～ 30° ,球管向头侧倾斜 15°是利于显示子宫动脉开口的最佳角度 ;单侧的子宫动脉卵巢支栓塞不会影响卵巢功能。     

子宫动脉开口摄影角度分析

目的 探讨子宫动脉开口在DSA图像上的“最易显示角度区间”.方法 对12例患者子宫动脉开口部CTA三维容积重建(VR)、最大密度投影(MIP)成像进行标准正位和旋转观察,在正位分析出子宫动脉开口与其附着动脉的内外关系,在左右斜位获得能清晰显示子宫动脉开口的小角度区间.对27例患者子宫动脉开口部用同样方法于DSA造影过程中验证这个区间的准确性.结果 41支子宫动脉开口位于附着动脉外侧,向对侧倾斜10°～40°可显示清晰;13支开口位于附着动脉内侧,向同侧倾斜30°～50°显示清晰;24支开口位于附着动脉前方,大角度倾斜40°～60°显示清晰.结论 “最易显示角度区间”能很轻易、清晰显示子宫动脉开口.     

子宫肌瘤的血管影像学表现及多中心观察子宫动脉栓塞治疗近期疗效

目的 总结经子宫动脉介入栓塞治疗的病例1151例,探讨子宫肌瘤的血液供应特点,评价栓塞的临床疗效.方法 总结陕西省多个医疗机构1995年1月至2002年12月1151例子宫肌瘤介入栓塞病例资料.所有病例均采用改良Seldinger法,经单侧或双侧股动脉选择插入子宫肌瘤供血动脉内并行超液态碘化油加平阳霉素混合液栓塞瘤血管床至瘤染色消失.术后第3、6、12个月复查B超,观察瘤体大小.结果 子宫动脉起源于髂内动脉前干、髂内动脉主干、臀下阴部干、阴部内动脉、臀上动脉的比率依次为73.8%、12.6%、7.6%、4.5%、1.6%.子宫动脉起始段成角分别为锐角63.4%、直角22.1%、钝角14.5%.DSA能清楚显示子宫动脉开口及行程的投照体化分别为:正位18.5%、同侧斜位56.2%、对侧斜位71.6%,提示对侧斜位投照为显示子宫动脉开口及行程的最佳体位.子宫肌瘤供血情况:早双侧优势型约占65.3%、呈双侧子宫动脉供血单侧优势型约占24.7%、呈单侧供血型约占10.1%.瘤体染色特点:单侧或双侧子宫动脉主干明显增粗、迂曲,动脉期肿瘤血管增多、增粗、扭曲,形成抱球状血管网,瘤巢内血管增多、紊乱,聚集呈毛线团状结构,称毛线团征;实质期,单发肌瘤瘤体呈浓密均匀染色,轮廓清楚.多发肿瘤呈边缘呈波浪状染色;肿瘤染色清晰显示瘤体的大小、形态、边缘.术后3、6、12个月复查超声瘤体缩小比率:3个月缩小1/2的约31%,6个月缩小1/2的约61%,12个月缩小1/2的约78%,约6.9%瘤体大小无变化.约1.4%无效.结论 大样本多中心观察表明,子宫肌瘤是富血供良性肿瘤,大样本子宫动脉栓塞术证明有良好的近期疗效;了解子宫动脉的血管解剖特点、采取合适的投照体位,可以明显提高超选择插管的成功率;认清栓塞后综合征的发生机理和采取必要的处理措施可以预防并发症、特别是严重并发症的发生.     

子宫动脉造影解剖分析及对栓塞治疗子宫肌瘤的指导意义

目的研究子宫肌瘤血管造影表现特点及其临床价值。方法75例患者,经临床症状,彩超和(或)CT检查确诊子宫肌瘤,其中黏膜下肌瘤9例,肌壁间肌瘤50例,浆膜下肌瘤16例;单发肌瘤21例,多发肌瘤54例。经右侧股动脉穿刺插管,导管分别插入双侧子宫动脉造影,观察内容包括：子宫动脉的起源及其分支、不同类型子宫肌瘤的血管造影表现,然后进行栓塞治疗。结果①大多数患者子宫动脉大部分发自髂内动脉的臀下动脉阴部干,其次为髂内动脉主干和臀上动脉。②子宫肌瘤供血情况分为：a、一侧子宫动脉供血为主型。b、双侧子宫动脉均衡供血型。c、单纯一侧子宫动脉供血型。③卵巢支的栓塞几乎不可避免,其临床后果仍存在争议。结论子宫动脉栓塞是治疗子宫肌瘤的一种安全有效的方法,熟悉子宫肌瘤的血管解剖对提高技术成功率、合理选用栓塞方法有重要意义。     

子宫动脉DSA造影解剖分析及其临床意义

目的：探讨子宫肌瘤患者的血管造影表现及其诊断与介入治疗中的价值。方法：70例患者，经临床症状，彩超和（或）凹检查确诊子宫肌瘤，单发肌瘤52例，多发肌瘤18例；其中黏膜下肌瘤7例，肌壁间肌瘤51例，浆膜下肌瘤12例。经右侧或左侧股动脉穿刺插管，导管分别插至双侧子宫动脉造影，观察内容包括：子宫动脉的起源及其走行、分布、血供程度、肌瘤表现和特点，然后进行栓塞治疗。结果：①大多数患者子宫动脉大部分发自髂内动脉的臀下动脉阴部干，其次为髂内动脉主干和臀上动脉；②子宫肌瘤供血情况分为：a、一侧子宫动脉供血为主型。b、双侧子宫动脉均衡供血型。c、单纯一侧子宫动脉供血型；③大多数子宫动脉发出卵巢支，子宫肌瘤栓塞术不能避免栓塞卵巢支。结论：子宫动脉栓塞是治疗子宫肌瘤的一种安全有效的方法，熟悉子宫肌瘤的血管解剖对提高技术成功率、合理选用栓塞方法有重要意义。     

子宫动脉血管内介入操作的技术分析

近年来,国内外已熟练开展利用子宫动脉栓塞术(uterine artery embolization,UAE)治疗子宫肌瘤,且已取得良好的临床治疗效果.但是盆腔空间相对狭窄,血管分支多,各血管分支易前后重叠,子宫动脉开口起源复杂,走行迂曲,髂内动脉与髂总动脉之间的夹角变化大,因此,子宫动脉起源、开口的清晰显示,熟练的子宫动脉内插管操作及适度的栓塞是该项技术治疗成功的关键.     

子宫动脉选择性插管方法的改良

通常子宫动脉选择性插管采取Seldinger技术经皮股动脉穿刺、置鞘、插管[1～3],以Cobra或者Robert导管进行.造影取正位或左右斜位显示子宫动脉[1,2,4～7].该方法有如下缺陷:①股动脉途径操作时术者手、臂部接近盆腔易受辐射;②正位或左右斜位均不能很好显示子宫动脉开口及起始段;③同侧子宫动脉插管时无法行导丝引导,对侧子宫动脉也常常不易选择性深插.     

子宫肌瘤栓塞治疗操作技术及相关因素分析

目的 :对子宫肌瘤动脉栓塞治疗的操作技术及相关因素进行分析 ,以提高技术成功率 ,减少并发症和X线辐射。方法 :对 10 6例行子宫肌瘤动脉栓塞治疗的患者进行回顾性分析 ,比较不同设备和技术条件下的技术成功率 ,并比较用不同投照角度造影对子宫动脉的显示情况。结果 :早期在旧设备下治疗的 2 1例患者 ,有 2支子宫动脉插管未成功。后在新设备下治疗 85例 ,全部子宫动脉插管成功。正位造影子宫动脉显示满意和比较满意的占 9.0 %和 2 4.0 %,右倾斜和左倾斜 3 0°～ 40°造影分别为 5 4.0 %和 2 9.9%,两者差异有显著性意义。结论 :要安全、快捷地进行子宫肌瘤动脉栓塞治疗 ,良好的操作技术和设备条件是基础。为清楚显示子宫动脉起始处以指导插管 ,取左和右倾斜造影 3 0°～ 40°较正位要好。     

臀部创伤性假性动脉瘤的栓塞治疗及其并发症

目的 探讨臀部创伤性假性动脉瘤的栓塞治疗方法及其并发症。资料与方法 9例臀部创伤性假性动脉瘤患者,行选择性动脉插管至载瘤动脉,造影明确诊断后采用明胶海绵和／或弹簧钢圈栓塞,并对栓塞治疗的方法和可能出现的并发症进行分析。结果 9例均发生于髂内动脉分支,其中臀上动脉3例,阴部内动脉3例,臀下动脉2例,闭孔动脉1例,均成功栓塞,随访2个月均痊愈,无严重并发症发生。结论 经导管栓塞臀部创伤性假性动脉瘤是一种安全、有效且并发症少的治疗方法。     

动脉栓塞治疗男性先天性盆腔动静脉畸形一例

报道1例长期原因不明肉眼血尿多囊肾患者。影像检查显示两侧盆区动静脉畸形(CPAVM)。经超选择栓塞髂内动脉8支分支血尿治愈,随访6个月,血尿无复发。文献复习表明CPAVM发病甚少,形态多样。介入治疗是有效的微创方法。     

Patient Presentation and Management of Labial Ulceration Following Uterine Artery Embolization

Uterine artery embolization is a safe and effective procedure for the treatment of symptomatic uterine fibroids. Nontarget embolization of adjacent internal iliac artery branches is a reported complication of uterine artery embolization. The following report describes the presentation and management of ulcerations of the labium minora due to nontarget embolization of the internal pudendal artery.     

前列腺供血动脉的来源及临床意义

目的观察DSA下前列腺供血动脉的来源,为动脉栓塞治疗前列腺增生提供参考。方法对72例选择性及超选择性插管成功病例,进行前列腺供血动脉造影,观察并记录前列腺供血动脉的来源、个数、优势供血动脉。结果前列腺供血动脉复杂(72例,共237支供血动脉),常有数支动脉同时参与供血,主要的起源动脉和个数为:膀胱下动脉69支、髂内动脉63支、阴部内动脉52支、直肠下动脉29支、膀胱上动脉14支。优势供血动脉63支,主要来源为:髂内动脉3支、膀胱下动脉20支、阴部内动脉6支和直肠下动脉2支。结论动脉造影检查可对前列腺供血动脉的来源和优势供血动脉作出正确判断,对指导介入栓塞治疗具有重要的临床意义。     

Aberrant Ovarian Collateral Originating from External Iliac Artery During Uterine Artery Embolization

We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE.     

Prostatic Arterial Supply: Anatomic and Imaging Findings Relevant for Selective Arterial Embolization

PurposeTo describe the anatomy and imaging findings of the prostatic arteries (PAs) on multirow-detector pelvic computed tomographic (CT) angiography and digital subtraction angiography (DSA) before embolization for symptomatic benign prostatic hyperplasia (BPH).Materials and MethodsIn a retrospective study from May 2010 to June 2011, 75 men (150 pelvic sides) underwent pelvic CT angiography and selective pelvic DSA before PA embolization for BPH. Each pelvic side was evaluated regarding the number of independent PAs and their origin, trajectory, termination, and anastomoses with adjacent arteries.ResultsA total of 57% of pelvic sides (n = 86) had only one PA, and 43% (n = 64) had two independent PAs identified (mean PA diameter, 1.6 mm ± 0.3). PAs originated from the internal pudendal artery in 34.1% of pelvic sides (n = 73), from a common trunk with the superior vesical artery in 20.1% (n = 43), from the anterior common gluteal–pudendal trunk in 17.8% (n = 38), from the obturator artery in 12.6% (n = 27), and from a common trunk with rectal branches in 8.4% (n = 18). In 57% of pelvic sides (n = 86), anastomoses to adjacent arteries were documented. There were 30 pelvic sides (20%) with accessory pudendal arteries in close relationship with the PAs. No correlations were found between PA diameter and patient age, prostate volume, or prostate-specific antigen values on multivariate analysis with logistic regression.ConclusionsPAs have highly variable origins between the left and right sides and between patients, and most frequently arise from the internal pudendal artery.     

Uterine Artery Anatomy Relevant to Uterine Leiomyomata Embolization

To categorize the anatomic variants of uterine arteries, and determine the incidence of menopausal symptoms where the tubo-ovarian branches were seen prior to embolization. Between July 1997 and June 2000, 257 (n = 257) uterine fibroid embolizations were performed at our institution. Arteriograms were retrospectively evaluated. Uterine arteries were classified into groups: type I (the uterine artery as first branch of the inferior gluteal artery), type II (the uterine artery as second or third branch of the inferior gluteal artery), type III (the uterine artery, the inferior gluteal and the superior gluteal arteries arising as a trifurcation), type IV (the uterine artery as first branch of the hypogastric artery), inconclusive, or not studied. Tubo-ovarian branches were recorded if visualized prior to and/or after embolization. Menopausal symptoms were recorded (n = 175 at 3 months, n = 139 at 6 months, n = 98 at 1 year, n = 22 at 2 years) using written questionnaires. Five hundred and fourteen uterine arteries (n = 514) were evaluated. There were 38% classifiable types, 23% inconclusive, and 39% not studied. Classification was as follows: type I, 45%; type II, 6%; type III, 43%; type IV, 6%. Among 256 patients, tubo-ovarian arteries were seen in 36 prior to embolization, but not afterwards. In this group, 25 patients reported transient menopausal symptoms (hot flashes, amenorrhea). Five patients did not report any menopausal symptoms. Six patients did not answer the questionnaires. Type I is the most common type of anatomy, followed by type III. The tubo-ovarian arteries may be visualized prior to and/or after embolization. The embolization was monitored to avoid embolization of the tubo-ovarian branches. Menopausal symptoms were transient all patients when the tubo-ovarian branches were seen prior to embolization.     

Spiral computed tomography in the assessment of vascular lesions of the pelvis due to blunt trauma

PURPOSE: We investigated the role of Helical Computed Tomography (CT) in the evaluation of low or high flow vascular injuries in patients with blunt pelvic trauma. MATERIAL AND METHODS: From May 1998 to December 1999, forty-nine patients (32 men and 17 women, ranging in age 14-59 years) with acute symptoms from blunt pelvic trauma were submitted to Computed Tomography (CT). A conventional radiography of the pelvis had been performed in all cases. CT was performed with a helical unit (thickness 8 mm, reconstruction interval 8 mm, pitch 1.5) after intravenous contrast agent (150-180 mL) rapid infusion (4-5 mL/s, 60 s acquisition delay from bolus starting) and using a power injector. A second spiral acquisition was performed in all cases from the iliac roofs to the inferior border of the pubic symphysis. Vascular hemorrhage was considered as low flow when the hematoma appeared as a focal homogeneous density area and as high flow when associated with contrast agent extravasation. Moreover, traumatic assessment included evaluation of the hematoma, of the leakage site and of the involved vessel. RESULTS: Radiologic examination of the pelvis revealed fractures in 35/49 patients (71.4%). Helical CT allowed us to identify low flow hemorrhage in 37 patients, affected with hematomas from fracture of the iliac wing or of the sacrum (14 cases), tear of the pelvic (3 cases) or extrapelvic (4 cases) muscular structures, or injury of the venous plexus (20 cases). In four patients two vascular injuries were detected. High flow hemorrhage was seen in 12 patients, who had Helical CT findings of contrast agent extravasation along the common iliac vein (3 cases), external iliac artery (3 cases), internal iliac artery (4 cases), internal pudendal artery (1 case), obturator artery (1 case), inferior epigastric artery (2 cases), superior gluteal artery (2 cases), inferior gluteal artery (1 case), cremasteric artery (1 case). In 6 patients with high flow hemorrhage, two vascular injuries were shown. In all these patients, an extraperitoneal hematoma was associated with the contrast agent extravasation. DISCUSSION AND CONCLUSIONS: Fractures of the pelvic ring generally result from severe trauma. Management of these injuries must include not only treatment of the skeletal trauma but also of the associated shock and complications. Major blood loss usually occurs as a result of bleeding from the branches of the internal iliac artery. With respect to pelvic plain radiography, CT provides superior detailing of fractures, position of fracture fragments and extent of diastasis of the sacroiliac joints and pubic symphysis. Moreover CT provides diagnostic information regarding the presence or absence of pelvic bleeding and can identify the site of bleeding. In our experience, Helical CT allows us to distinguish high flow hemorrhage, where vascular injuries must be treated first, from low flow hemorrhage which can be managed differently.     

Can CT predict the source of arterial hemorrhage in patients with pelvic fractures?

The objective of the study was to evaluate the ability of hemorrhage site and location as demonstrated on pelvic CT to predict the source of arterial hemorrhage in patients with traumatic pelvic fractures. CT scans of 104 consecutive patients who had sustained traumatic pelvic fracture and undergone emergent pelvic angiography were digitized, and fracture-related hemorrhage area and volume were measured at multiple locations within the pelvis. Clots that measured greater than 10 cm² were compared to angiographic results. The χ² test was used to find locations on CT that were significantly associated with specific arterial injuries found on angiography. Sixty-one (58%) of the patients had arterial bleeding at angiography. The most commonly injured arteries were the internal pudendal and the superior gluteal. Specific locations on CT were statistically significant indicators of injury to the superior gluteal artery (relative risk=2.9, 95% CI 1.2–7.3, P=0.013), the anterior division of the internal iliac artery (relative risk=3.2, 95% CI 1.4–4.1, P=0.006), and the internal pudendal arteries (relative risk=2.0, 95% CI 1.1–4.0, P=0.037). More blood was visible on CT when an artery was injured (mean volume with negative angiogram=318 ml, mean volume with positive angiogram=554 ml, (P=0.007)). The rectus sheath region at the top of the iliac crest (P=0.004), pelvic sidewalls at the L5–S1 disk space level (P=0.001), and gluteal regions also at the L5–S1 disk space level (P=0.012) were significant indicators of a positive arteriogram. CT can help predict the specific bleeding artery to potentially guide angiographic intervention. Electronic Publication