3D-DSA与CTA在子宫动脉开口定位与最佳显示角度中的临床应用研究

发布时间：2018-03-28 11:38

本文选题：3D-DSA　切入点：CTA　出处：《蚌埠医学院》2014年硕士论文

【摘要】：目的：利用3D-DSA(Three-dimensional digital subtraction angiography,3D-DSA)及CTA（Computed Tomography Angiography）对子宫动脉进行研究，寻找子宫动脉开口的最佳显示角度范围，探讨子宫动脉开口与髂内动脉及臀上动脉的位置关系，为子宫动脉（uterine artery，UA）插管提供数据参考，优化超选择子宫动脉插管步骤。方法：以3D-DSA组及CTA组进行对比研究： 1.3D-DSA组对接受介入治疗的40例患者进行3D-DSA造影，患者年龄20～43岁，平均26.98±5.24岁。其中疤痕妊娠出血22例，剖宫产后出血5例，胎盘植入5例，侵袭性葡萄胎3例，宫颈癌3例，子宫肌瘤2例。造影结束后将图像在后处理工作站进行三维处理及分析，，处理后图像采取每间隔5°旋转，观察及测量子宫动脉切线位显示角度、子宫动脉起源和子宫动脉开口距臀上动脉及髂内动脉开口距离。 2.CTA组选择36例患者，并且无盆腔手术和严重盆腔炎症病史的女性患者，在征得本人书面同意后纳入研究，患者年龄31～43岁，平均36.89±2.98岁。采用GE Lightspeed64排螺旋CT机对患者进行CT平扫及增强扫描，扫描范围自双侧髂前上棘至耻骨联合。增强扫描时，应用高压注射器自患者肘静脉以2ml/s流率注入对比剂碘普罗胺30060ml后，对整个盆腔经行动脉期扫描，将获得的原始图像传至工作站作后处理。观察子宫动脉切线位显示角度；统计子宫动脉起源；以臀上动脉开口及髂内动脉开口为定位点，测量子宫动脉开口距臀上动脉及髂内动脉开口距离。结果：1.所有76例152侧子宫动脉均能清楚显示其开口部位及走行方向。通过对比可发现在对侧斜位和同侧斜位30°～45°范围内，3D-DSA组中子宫动脉能够清晰显示的比率分别是50.0%和47.5%，CTA组中子宫动脉能够清晰显示的比率分别是51.4%和47.2%，此角度范围内显示子宫动脉可呈切线位显示。采用X2检验，同侧斜位与对侧斜位投照对子宫动脉开口显示的差异无统计学意义（p=0.560）。将3D-DSA组与CTA组作为两独立样本进行非参数检验，对侧斜位不同投照角度做分析，分析结果z=-0.70，p=0.484，差异无统计学意义。同侧斜位不同投照角度做分析，分析结果z=-0.35，p=0.727，差异无统计学意义。 2.本次研究的152侧子宫动脉中，104侧子宫动脉起源于髂内动脉脏支，占68.42%，其距臀上动脉距离为12.17±4.52mm，距髂内动脉距离为52.28±10.48mm；31侧起源于臀下阴部干，占20.39%，其距臀上动脉距离为16.43±5.00mm，距髂内动脉距离为55.30±8.00mm；11侧起源于髂内动脉主干，占7.23%，其距臀上动脉的距离为6.55±3.46mm，距髂内动脉距离为52.95±12.80mm；6侧起源于阴部内动脉，占3.95%，距臀上动脉距离为19.63±1.69mm，距髂内动脉距离为62.65±3.36mm。结论：1.3D-DSA与CTA检查方法在子宫动脉最佳显示角度中差异无统计学意义； 2.3D-DSA与CTA造影显示同侧斜位与对侧斜位投照对子宫动脉开口显示的差异无统计学意义，而同侧或对侧斜位投照30°～45°为子宫动脉开口最佳投照角度范围，更好显示子宫动脉起源及走行，优化子宫动脉插管步骤； 3.子宫动脉主要起源于髂内动脉脏支，其次为臀下阴部干，而子宫动脉开口至臀上动脉开口距离约12.92±5.24mm，至髂内动脉开口距离约53.36±10.19mm，据此可根据对子宫动脉开口进行初步定位。
[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.

【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.4

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