本文選題：3D-DSA　切入點(diǎn)：CTA　出處：《蚌埠醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：利用3D-DSA(Three-dimensional digital subtraction angiography,3D-DSA)及CTA（Computed Tomography Angiography）對(duì)子宮動(dòng)脈進(jìn)行研究，尋找子宮動(dòng)脈開口的最佳顯示角度范圍，探討子宮動(dòng)脈開口與髂內(nèi)動(dòng)脈及臀上動(dòng)脈的位置關(guān)系，為子宮動(dòng)脈（uterine artery，UA）插管提供數(shù)據(jù)參考，優(yōu)化超選擇子宮動(dòng)脈插管步驟。 方法：以3D-DSA組及CTA組進(jìn)行對(duì)比研究： 1.3D-DSA組對(duì)接受介入治療的40例患者進(jìn)行3D-DSA造影，患者年齡20～43歲，平均26.98±5.24歲。其中疤痕妊娠出血22例，剖宮產(chǎn)后出血5例，胎盤植入5例，侵襲性葡萄胎3例，宮頸癌3例，子宮肌瘤2例。造影結(jié)束后將圖像在后處理工作站進(jìn)行三維處理及分析，，處理后圖像采取每間隔5°旋轉(zhuǎn)，觀察及測(cè)量子宮動(dòng)脈切線位顯示角度、子宮動(dòng)脈起源和子宮動(dòng)脈開口距臀上動(dòng)脈及髂內(nèi)動(dòng)脈開口距離。 2.CTA組選擇36例患者，并且無盆腔手術(shù)和嚴(yán)重盆腔炎癥病史的女性患者，在征得本人書面同意后納入研究，患者年齡31～43歲，平均36.89±2.98歲。采用GE Lightspeed64排螺旋CT機(jī)對(duì)患者進(jìn)行CT平掃及增強(qiáng)掃描，掃描范圍自雙側(cè)髂前上棘至恥骨聯(lián)合。增強(qiáng)掃描時(shí)，應(yīng)用高壓注射器自患者肘靜脈以2ml/s流率注入對(duì)比劑碘普羅胺30060ml后，對(duì)整個(gè)盆腔經(jīng)行動(dòng)脈期掃描，將獲得的原始圖像傳至工作站作后處理。觀察子宮動(dòng)脈切線位顯示角度；統(tǒng)計(jì)子宮動(dòng)脈起源；以臀上動(dòng)脈開口及髂內(nèi)動(dòng)脈開口為定位點(diǎn)，測(cè)量子宮動(dòng)脈開口距臀上動(dòng)脈及髂內(nèi)動(dòng)脈開口距離。 結(jié)果：1.所有76例152側(cè)子宮動(dòng)脈均能清楚顯示其開口部位及走行方向。通過對(duì)比可發(fā)現(xiàn)在對(duì)側(cè)斜位和同側(cè)斜位30°～45°范圍內(nèi)，3D-DSA組中子宮動(dòng)脈能夠清晰顯示的比率分別是50.0%和47.5%，CTA組中子宮動(dòng)脈能夠清晰顯示的比率分別是51.4%和47.2%，此角度范圍內(nèi)顯示子宮動(dòng)脈可呈切線位顯示。采用X2檢驗(yàn)，同側(cè)斜位與對(duì)側(cè)斜位投照對(duì)子宮動(dòng)脈開口顯示的差異無統(tǒng)計(jì)學(xué)意義（p=0.560）。將3D-DSA組與CTA組作為兩獨(dú)立樣本進(jìn)行非參數(shù)檢驗(yàn)，對(duì)側(cè)斜位不同投照角度做分析，分析結(jié)果z=-0.70，p=0.484，差異無統(tǒng)計(jì)學(xué)意義。同側(cè)斜位不同投照角度做分析，分析結(jié)果z=-0.35，p=0.727，差異無統(tǒng)計(jì)學(xué)意義。 2.本次研究的152側(cè)子宮動(dòng)脈中，104側(cè)子宮動(dòng)脈起源于髂內(nèi)動(dòng)脈臟支，占68.42%，其距臀上動(dòng)脈距離為12.17±4.52mm，距髂內(nèi)動(dòng)脈距離為52.28±10.48mm；31側(cè)起源于臀下陰部干，占20.39%，其距臀上動(dòng)脈距離為16.43±5.00mm，距髂內(nèi)動(dòng)脈距離為55.30±8.00mm；11側(cè)起源于髂內(nèi)動(dòng)脈主干，占7.23%，其距臀上動(dòng)脈的距離為6.55±3.46mm，距髂內(nèi)動(dòng)脈距離為52.95±12.80mm；6側(cè)起源于陰部?jī)?nèi)動(dòng)脈，占3.95%，距臀上動(dòng)脈距離為19.63±1.69mm，距髂內(nèi)動(dòng)脈距離為62.65±3.36mm。 結(jié)論：1.3D-DSA與CTA檢查方法在子宮動(dòng)脈最佳顯示角度中差異無統(tǒng)計(jì)學(xué)意義； 2.3D-DSA與CTA造影顯示同側(cè)斜位與對(duì)側(cè)斜位投照對(duì)子宮動(dòng)脈開口顯示的差異無統(tǒng)計(jì)學(xué)意義，而同側(cè)或?qū)?cè)斜位投照30°～45°為子宮動(dòng)脈開口最佳投照角度范圍，更好顯示子宮動(dòng)脈起源及走行，優(yōu)化子宮動(dòng)脈插管步驟； 3.子宮動(dòng)脈主要起源于髂內(nèi)動(dòng)脈臟支，其次為臀下陰部干，而子宮動(dòng)脈開口至臀上動(dòng)脈開口距離約12.92±5.24mm，至髂內(nèi)動(dòng)脈開口距離約53.36±10.19mm，據(jù)此可根據(jù)對(duì)子宮動(dòng)脈開口進(jìn)行初步定位。
[Abstract]:Objective: using 3D-DSA (Three-dimensional digital subtraction angiography, 3D-DSA) and CTA (Computed Tomography Angiography) of uterine artery, uterine artery opening for the best display angle range, uterine arterial position openings and artery and internal iliac artery of the hip for uterine artery (uterine, artery, UA) to provide reference data for intubation optimization, superselective uterine artery intubation procedure.
Methods: a comparative study was conducted between group 3D-DSA and group CTA.
40 cases in 1.3D-DSA group accepted interventional therapy in patients with 3D-DSA angiography, patients age 20~43 years, average 26.98 + 5.24 years old. The scar pregnancy bleeding in 22 cases, 5 cases of postpartum hemorrhage of cesarean section, 5 cases of placenta, 3 cases of invasive hydatidiform mole, 3 cases of cervical carcinoma, 2 cases of uterine fibroids after angiography. In the image postprocessing workstation for 3D image processing and analysis, take every 5 degrees rotation, observation and measurement of uterine artery shows the tangent angle, the origin of uterine artery and uterine artery opening from the superior gluteal artery and internal iliac artery distance.
2.CTA group of 36 patients, female patients with and without pelvic surgery and severe pelvic inflammatory disease, included in the study in the written consent after I, patients age 31~43 years, average 36.89 + 2.98 years. Using GE Lightspeed64 slice spiral CT with CT scan and enhanced scan, scan range from bilateral anterior superior iliac spine to the pubic symphysis. Enhanced scanning, application of high pressure injector from patients with elbow vein injection with the rate of 2ml/s contrast medium-omnipaque370 30060ml after the whole pelvic cavity after arterial phase scanning, the original image will be transmitted to the workstation as after treatment. Observation of uterine artery showed statistical tangent angle; uterine artery origin; opening to superior gluteal artery and internal iliac artery openings for positioning, measuring the distance between the opening of uterine artery of superior gluteal artery and internal iliac artery opening distance.
Results: 1. of all 76 cases 152 sides of uterine artery can clearly demonstrate the opening position and direction. By contrast can be found in the contralateral and ipsilateral oblique oblique 30 degrees to 45 degrees within the ratio of uterine artery in the 3D-DSA group can clearly display are respectively 50% and 47.5%, the ratio of uterine artery CTA in the group can clearly display are respectively 51.4% and 47.2%, the angle range can display the uterine artery with a tangent display. By X2 test, the ipsilateral and contralateral oblique oblique projection difference on uterine artery opening showed no statistical significance (p=0.560). The 3D-DSA group and CTA group as two independent samples non parametric tests are performed on different lateral oblique projection angle analysis, the analysis results of z=-0.70, p=0.484, the difference was not statistically significant. With different lateral oblique projection angle analysis, z=-0.35 analysis, p=0.727, the difference was not statistically significant.
The 152 side of the uterine artery 2., 104 side of uterine artery originated from the iliac artery accounted for 68.42%, the dirty branch from the superior gluteal artery distance was 12.17 + 4.52mm, from the internal iliac artery distance was 52.28 + 10.48mm; the 31 side originated from the buttock genitals under dry, accounted for 20.39%, the distance of superior gluteal artery the distance is 16.43 + 5.00mm, from the internal iliac artery distance was 55.30 + 8.00mm; 11 side arteries originated from internal iliac artery, accounting for 7.23%, the distance from the superior gluteal artery was 6.55 + 3.46mm, from the internal iliac artery distance was 52.95 + 12.80mm; the 6 side originated from the internal pudendal artery, accounting for 3.95%, from the hip arterial distance was 19.63 + 1.69mm, from the internal iliac artery distance was 62.65 + 3.36mm.
Conclusion: there is no significant difference between the 1.3D-DSA and CTA methods in the best angle of the uterine artery.
2.3D-DSA and CTA imaging showed ipsilateral and contralateral oblique oblique projection difference on uterine artery opening showed no statistically significant, while the ipsilateral or contralateral oblique projection of 30 degrees to 45 degrees for uterine artery opening the optimal projection angle range, better display and go for the origin of uterine artery and uterine artery optimization intubation steps;
3., the uterine artery mainly originated from the internal iliac artery, followed by the inferior gluteal trunk, and the opening of the uterine artery to the superior gluteal artery was about 12.92 + 5.24mm, and the distance from the uterine artery to the internal iliac artery was about 53.36 + 10.19mm. Accordingly, the uterine artery opening could be initially located.

【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R713.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 何富生;郭軍;王端福;王麗;閻莉;;子宮動(dòng)脈栓塞及留置導(dǎo)管持續(xù)灌注介入治療妊娠滋養(yǎng)細(xì)胞腫瘤[J];當(dāng)代醫(yī)學(xué);2009年11期

2 李克攻;人體斷層解剖與臨床[J];大理醫(yī)學(xué)院學(xué)報(bào);1999年04期

3 林振文;初虹;竇永充;張彥舫;;丙烯酸膠原微球與聚乙烯醇顆粒治療子宮肌瘤的術(shù)后反應(yīng)對(duì)比[J];放射學(xué)實(shí)踐;2011年01期

4 李華;徐圣德;高斌;張宇東;汪濤;許國(guó)忠;;介入治療在宮頸癌臨床治療中的應(yīng)用[J];安徽衛(wèi)生職業(yè)技術(shù)學(xué)院學(xué)報(bào);2013年04期

5 單錦露,張紹祥,劉正津,譚立文,林支付,唐澤圣;中國(guó)數(shù)字化可視人女性盆腔的計(jì)算機(jī)三維重建[J];解剖學(xué)雜志;2005年03期

6 席嘉元,任淑平,呂梁,焦存仙,劉云霞,楊玨,鄧剛,李紀(jì)康,曹新華,米嵐;急診介入栓塞止血治療產(chǎn)后大出血臨床研究[J];介入放射學(xué)雜志;2002年06期

7 張大忠;殷建林;劉海日;張富強(qiáng);黃海;顧友梅;;碘油平陽(yáng)霉素乳劑和聚乙烯醇顆粒栓塞子宮肌瘤的臨床研究[J];介入放射學(xué)雜志;2010年01期

8 呂維富;張愛武;周春澤;魯東;肖景坤;王偉昱;張行明;張正峰;侯昌龍;;子宮動(dòng)脈的三維DSA表現(xiàn)及其最佳顯示體位探討[J];介入放射學(xué)雜志;2011年11期

9 徐強(qiáng);黃優(yōu)華;石紅建;沈濤;周華明;吳小松;蔣磊;陳靜;儲(chǔ)菊妹;;葡聚糖微球經(jīng)子宮動(dòng)脈栓塞子宮肌瘤的臨床療效[J];介入放射學(xué)雜志;2011年12期

10 單錦露;張紹祥;譚立文;;盆腔動(dòng)脈三維重建研究及其臨床意義[J];中國(guó)介入影像與治療學(xué);2007年05期

相關(guān)碩士學(xué)位論文 前3條

1 杜敏敏;婦科盆腔血管CT三維成像（3D-CTA）的臨床意義探討[D];山東大學(xué);2011年

2 朱文麗;子宮動(dòng)脈栓塞治療子宮肌瘤的應(yīng)用解剖學(xué)研究[D];山西醫(yī)科大學(xué);2012年

3 孫光;通過血管鑄型技術(shù)及CT三維重建來探討子宮血管分布及血管網(wǎng)的意義[D];大連醫(yī)科大學(xué);2012年

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