C臂锥体束CT技术在前列腺动脉栓塞术中的应用价值

A preliminary study on application value of Cone Beam CT in prostate arterial embolization

目的:初步评价C臂锥体束CT(Cone Beam CT,CBCT)技术在前列腺动脉栓塞术(PAE)治疗前列腺增生中的临床应用价值。方法:回顾性分析2015年6月—2016年12月在我院进行前列腺动脉栓塞治疗的12例前列腺增生患者的临床资料,所有患者在进行前列腺动脉插管造影时均进行CBCT检查,以明确前列腺动脉的正确插管位置,预防非靶器官的误栓。经CBCT证实后,在透视下用100~300μm直径的聚乙烯醇(PVA)颗粒栓塞前列腺动脉,术后观察患者血尿症状、排尿困难的改善情况及是否出现并发症。结果:所有患者在DSA下超选择插管后均行CBCT检查并证实为前列腺动脉再行栓塞治疗。10例(83.3%)患者完成双侧前列腺动脉栓塞,2例(16.7%)患者因血管扭曲插管困难行单侧前列腺动脉栓塞。8例患者术后1~2周内成功拔除尿管,在1个月随访时排尿保持通畅,有效率67.7%(8/12)。3例合并血尿症状的患者术后出血即停止,1个月随访未出现血尿症状,止血有效率100%。所有患者均未出现因膀胱、直肠、阴茎等邻近器官供血动脉栓塞导致的缺血坏死等严重并发症。结论:CBCT在动脉栓塞治疗前列腺增生疾病中有着重要作用,是保证前列腺动脉充分栓塞和避免误栓的重要影像学监测手段。

Objective:To evaluate the clinical value of Cone Beam CT(CBCT)technology in prostatic artery embolization(PAE)in treating prostatic hyperplasia.Methods:A retrospective analysis of clinical data of12patients with benign prostate hyperplasia who received PAE in our department during June2015to December2016was performed.Polyvinyl alcohol(PVA)particles were used as embolization agent intraoperatively.CBCT was running during the PAE procedure to ensure a clear prostate gland artery intubation,preventing non-target organs embolization by mistake.Confirmed by CBCT,100μm to300μm diameter of PVA particles were injected into the prostate gland artery.The postoperative follow-up was made to observe these patients status with hematuria and any complications caused by embolization.Results:All of the patients were performed CBCT examination under DSA.10patients(83.3%)received bilateral prostatic artery embolism while the other2(16.7%)patients received unilateral prostatic artery embolism due to curved artery.All patients received embolization with CBCT imaging confirmation.8patients’urine tubes were removed successfully1～2weeks after the procedure,and these patients kept urine unobstructed without hematuria in the followup a month later,with efficiency being67.7%(8/12).Among the3patients with hematuria symptoms,the blood did not appear in the urine during the follow-up,thus,the hemostatic effectiveness was100%.No serious complications of ischemic necrosis in adjacent organs such as the bladder,rectum,and penis were observed.Conclusion:CBCT plays an important role in guiding PAE in precision and avoiding the postoperative complications.