本文選題：3D-DSA　切入點：CTA　出處：《蚌埠醫(yī)學院》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）對子宮動脈進行研究，尋找子宮動脈開口的最佳顯示角度范圍，探討子宮動脈開口與髂內(nèi)動脈及臀上動脈的位置關系，為子宮動脈（uterine artery，UA）插管提供數(shù)據(jù)參考，優(yōu)化超選擇子宮動脈插管步驟。 方法：以3D-DSA組及CTA組進行對比研究： 1.3D-DSA組對接受介入治療的40例患者進行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)，觀察及測量子宮動脈切線位顯示角度、子宮動脈起源和子宮動脈開口距臀上動脈及髂內(nèi)動脈開口距離。 2.CTA組選擇36例患者，并且無盆腔手術和嚴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機對患者進行CT平掃及增強掃描，掃描范圍自雙側(cè)髂前上棘至恥骨聯(lián)合。增強掃描時，應用高壓注射器自患者肘靜脈以2ml/s流率注入對比劑碘普羅胺30060ml后，對整個盆腔經(jīng)行動脈期掃描，將獲得的原始圖像傳至工作站作后處理。觀察子宮動脈切線位顯示角度；統(tǒng)計子宮動脈起源；以臀上動脈開口及髂內(nèi)動脈開口為定位點，測量子宮動脈開口距臀上動脈及髂內(nèi)動脈開口距離。 結(jié)果：1.所有76例152側(cè)子宮動脈均能清楚顯示其開口部位及走行方向。通過對比可發(fā)現(xiàn)在對側(cè)斜位和同側(cè)斜位30°～45°范圍內(nèi)，3D-DSA組中子宮動脈能夠清晰顯示的比率分別是50.0%和47.5%，CTA組中子宮動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)顯示子宮動脈可呈切線位顯示。采用X2檢驗，同側(cè)斜位與對側(cè)斜位投照對子宮動脈開口顯示的差異無統(tǒng)計學意義（p=0.560）。將3D-DSA組與CTA組作為兩獨立樣本進行非參數(shù)檢驗，對側(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)計學意義。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)計學意義。 2.本次研究的152側(cè)子宮動脈中，104側(cè)子宮動脈起源于髂內(nèi)動脈臟支，占68.42%，其距臀上動脈距離為12.17±4.52mm，距髂內(nèi)動脈距離為52.28±10.48mm；31側(cè)起源于臀下陰部干，占20.39%，其距臀上動脈距離為16.43±5.00mm，距髂內(nèi)動脈距離為55.30±8.00mm；11側(cè)起源于髂內(nèi)動脈主干，占7.23%，其距臀上動脈的距離為6.55±3.46mm，距髂內(nèi)動脈距離為52.95±12.80mm；6側(cè)起源于陰部內(nèi)動脈，占3.95%，距臀上動脈距離為19.63±1.69mm，距髂內(nèi)動脈距離為62.65±3.36mm。 結(jié)論：1.3D-DSA與CTA檢查方法在子宮動脈最佳顯示角度中差異無統(tǒng)計學意義； 2.3D-DSA與CTA造影顯示同側(cè)斜位與對側(cè)斜位投照對子宮動脈開口顯示的差異無統(tǒng)計學意義，而同側(cè)或?qū)?cè)斜位投照30°～45°為子宮動脈開口最佳投照角度范圍，更好顯示子宮動脈起源及走行，優(yōu)化子宮動脈插管步驟； 3.子宮動脈主要起源于髂內(nèi)動脈臟支，其次為臀下陰部干，而子宮動脈開口至臀上動脈開口距離約12.92±5.24mm，至髂內(nèi)動脈開口距離約53.36±10.19mm，據(jù)此可根據(jù)對子宮動脈開口進行初步定位。
[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.

【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R713.4

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