子宫动脉的三维DSA表现及其最佳显示体位探讨

3D DSA findings of uterine artery and its optimal projection position

目的用三维DSA观察子宫动脉的开口位置、解剖形态及最佳投照角度,以提高子宫动脉的插管成功率。方法对42例(84侧)成年女性子宫动脉进行前瞻性206°旋转DSA检查,对获取的图像进行三维重建,分析子宫动脉的DSA表现,并观察子宫动脉的最佳显示角度。结果所有84侧子宫动脉开口均能在三维DSA上清晰显示,其中58侧起源于髂内动脉前干,占69%;16侧起源于髂内动脉主干,占19.1%;8侧发自阴部内动脉,占9.5%;2侧起源于臀下动脉,占2.4%。子宫动脉开口在对侧斜位16.4°～43.7°能够清楚显示,其中20.2%(17/84)在对侧斜位15°～25°,54.8%(46/84)在对侧斜位25°～35°,25%(21/84)在对侧斜位35°～45°。子宫动脉开口和走行在对侧斜位25°～35°投照时的显示效果明显优于对侧斜位15°～25°和35°～45°(P<0.05)。结论三维DSA能清晰显示子宫动脉开口位置及解剖形态,选用对侧斜位25°～35°投照更有助于子宫动脉的显示和超选择性插管。

Objective To observe the origin site,anatomic features of uterine artery with 3D DSA and to discuss the optimal projection position in order to improve the success rate of super-selective catheterization of uterine artery.Methods Prospective pelvic angiography was performed in 42 adult females（a total of 84 uterine arteries）.3D DSA was carried out with 206° rotation.3D reconstruction of the obtained images was performed and the angiographic manifestations of the uterine artery were analyzed.The optimal projection position for the displaying of uterine artery was discussed.The quality of images obtained with the projection angle of 15°-25°,25°-35° and 35°-45° was determined and the results were compared with each other.Results The orifices of all 84 uterine arteries could be well demonstrated on 3D DSA images.The uterine artery was originated from the anterior trunk of internal iliac artery（n = 58,69%）,from main stem of internal iliac artery（n = 16,19.1%）,from internal pudenda artery（n = 8,9.5%） and from inferior gluteal artery（n = 2,2.4%）.The best projection position to show the opening and route of the uterine artery was contralateral oblique view of 25-35 degrees（P 0.05）.Conclusion 3D DSA can clearly display the anatomy of the uterine artery,which is very helpful for the management of super-selective catheterization of uterine artery.The optimal projection position for uterine artery is contralateral oblique view of 25-35 degrees.