盆腔动脉造影解剖研究及其临床意义

Study of pelviarteriographic anatomy and the clinical significance

目的探讨盆腔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,提高介入插管准确率及成功率。方法测量51例正常成人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;观察髂内动脉及其分支正位、对侧斜位、同侧斜位造影片上显示程度。结果①正常成年男性双侧髂总动脉夹角均数为(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)°,女性髂总动脉夹角大于男性;右侧髂内动脉开口高于左侧,左侧髂总动脉干长于右侧;②对侧斜位造影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走行及分布情况,正常成人髂内动脉可分为四种解剖类型。结论①女性患者因双侧髂总动脉间夹角较大,提示经皮股动脉穿刺对侧髂血管造影和介入治疗时宜采用直接插管技术,能提高手术成功率和缩短插管时间;男性患者可采取成袢技术;②选用对侧斜位有助于超选插管至髂内动脉及其分支;③对盆腔血管内介入治疗的病人应根据其髂内动脉及其分支的血管造影解剖类型、髂总动脉主干长度类型实行个体化介入手术操作。

Objective To study pelviarteriographic anatomy and find the best projected position for interventional catheterization and improving its success rate. Methods Aortography （in level of lumber 4） and bilateral common iliac arteriography were taken in 51 normal adults. The common iliac arteriography were observed and the angles between bilateral common iliac arteries were measured respectively in male and female group, the arising altitude of internal iliac arteries were compared. Three projected positions （posteroanterior, ipsilateral oblique and contralateral oblique view） were taken and the view aspects of internal iliac arteries were observed. Results ①The 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 male and female groups. The angle of bilateral common iliac arteries in females was larger than that of males＇. Arising of the internal iliac arteries in right was higher than in left. ②Contralateral oblique view was the best projected position to show the opening and route of the internal iliac artery. ③Internal iliac arteries can be divided into four anatomic types. Conclusion ①Because of the female patients＇ 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.②Contralateral oblique position is helpful for superselective catheterization of internal iliac arteries. ③According to internal iliac arteriography, the characteristic interventional procedures would better be carried out.