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。

The anatomic study of the internal iliac arteriography and its guidance for vascular interventional procedures

Objective:To study internal iliac arteriographic anatomy and to find the best projected position for the interventional catheterization,and to improve its success rate.Methods:(1)Aortography(in level of lumber 4) and bilateral common iliac arteriography were taken in 71 normal adults.The angles between bilateral common iliac arteries were measured in male and female groups,respectively.The Length of the common iliac artery and it's bifurcation of internal iliac arteries were compared.(2)Three projected positions(posteroanterior,ipsilateral and contralateral oblique view) were taken and the view aspects of internal iliac arteries were observed.(3)The angiographic manifestations and arteriographic anatomical types were analyzed.Results:(1)The average angle between bilateral common iliac arteries was 57.22°±8.39°in normal male adults,and 66.41°±7.99° in normal female adults.There was significant difference between that of male and female groups.The angle of bilateral common iliac arteries in females was larger than that of males'.The bifurcation of the common iliac arteries in right was higher than in left.(2)Contralateral oblique view was the best projected position to show the opening and route of the internal iliac artery.(3)Internal iliac arteries can be divided into four anatomic types.(4)Most uterine arteries arise from anterior trunk of iliac arteries.2.9% ascending branches of uterine arteries become ovary branches.Conclusion:(1)Because of the female patient's larger angle between bilateral common iliac arteries,it is recommended that direct catheterization be used with percutaneous femoral artery puncture technique for contralateral iliac procedures,while in male patients,loop catheterization be much better.(2)Contralateral oblique position is helpful for superselective catheterization of internal iliac arteries.(3)According to internal iliac arteriography,the characteristic interventional procedures would better be carried out.