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。

The application of in-vivo placenta increta three-dimensional model in uterine artery embolization

Objective To explore the method and significance of constructing digital three-dimensional(3D) model for placenta increta patients.Methods Between Sep.2010 and Dec.2010 in Nanfang Hospital of Southern Medical University 4 cases of placenta increta patients were included and scaned by dual-source Computerized Tomography(CT).After the original images were obtained,we used Mimics10.01 software to reconstruct digital 3D model of arterial network and pelvis.The placenta increta 3D models were used to guide the following uterine artery embolization(UAE) and compared with the digital subtraction angiography(DSA) images.Results The 3D models showed uterine artery of 1 patient(2 arteries) originated from internal iliac artery and 3 cases(6 arteries) from the inferior gluteal artery.The angle of uterine artery origin and its opening type can be accurately measured.Placental blood supply source: 3 cases from bilateral uterine artery and ovarian artery,and 1 only from bilateral uterine artery,but uterine-ovarian anastomotic vessels was found in this patient.Blood supply distribution was imbalanced and left-predominated in 3 patients and balanced in 1 case.Except for 1 patient required conservative treatment,the other 3 patients were successfully treated by UAE.No significant difference was found between DSA images and digital three-dimensional model in uterine artery origin and blood distribution.Conclusion The digital three-dimensional model of placenta increta has great guiding significance before and during UAE procedure and contributes to an accurate embolization.