逆向开口子宫动脉超选择性插管方式临床应用

Clinical application of different manipulation methods in superselective catheterization of uterine artery with reverse opening

目的评价不同操作方式在逆向开口子宫动脉超选择性插管中的应用。方法回顾性分析2015年9月至2021年8月共892例接受子宫动脉栓塞治疗患者临床资料,其中23例患者子宫动脉逆向开口。23例均为单侧子宫动脉逆向开口,左侧9例,右侧14例。根据不同超选择性插管方式分为A、B、C 3组,A组10例患者所用微导管头端经塑形,B组5例微导管成襻,C组8例猪尾导管头端经修剪自制。采用SPSS25.0软件进行统计学分析,Kruskal-Wallis秩和检验对比3组成功插管所用时长。结果23例患者均成功超选择插管至目标血管内。A组插管用时11~60 min,中位用时18.5 min;B组用时4~15 min,中位用时9.0 min;C组用时2~6 min,中位用时3.5 min。3种插管方式所用时长差异有统计学意义(均P<0.01)。结论子宫动脉逆向开口插管困难,采用微导管头端经塑形、微导管成襻及修剪猪尾导管头端方式可成功插管。猪尾导管头端修剪后更易于钩取子宫动脉,配合微导管可做到快速超选择性插管至子宫动脉内。

Objective To evaluate the application of different manipulation methods in superselective catheterization of uterine artery with reverse opening. Methods The clinical data of 892 patients, who received uterine artery embolization between September 2015 and August 2021, were retrospectively analyzed.Unilateral reverse opening of the uterine artery was found in 23 patients, which was on the left side in 9 patients and on the right side in 14 patients. According to manipulation methods of superselective catheterization, the patients were divided into group A(n = 10, using microcatheter with a shaped tip), group B(n=5, using microcatheter looping technique), and group C(n=8, using pig tail catheter with a self-made trimmed tip).SPSS 25.0 software was used to make statistical analysis, and Kruskal-Wallis rank-sum test was used to compare the time spent for a successful superselective catheterization among the three groups. Results Successful superselective catheterization of the target vessel was accomplished in all the 23 patients. The time spent for catheterization and the median time in group A, B and C were(11-60) minutes and 18.5 minutes,(4-15) minutes and 9.0 minutes, and(2-6) minutes and 3.5 minutes, respectively. The difference in the time spent for catheterization was statistically significant between each other among the three groups(all P<0.001). Conclusion It is difficult to complete catheterization in patients with reverse opening of the uterine artery. By using microcatheter with a shaped tip, microcatheter looping technique, or pig tail catheter with a self-made trimmed tip, the superselective catheterization of uterine artery with reverse opening can be successfully accomplished. The pig tail catheter with a trimmed tip can easily hook the opening of uterine artery, combined with the use of a microcatheter the superselective catheterization of the uterine artery can be rapidly achieved.(J Intervent Radiol, 2022, 31: 966-969)