CAJ | 학술논문

目的探讨利用CT血管成像术(CTA)原始数据集构建的在体骨盆及腹盆腔动脉血管网数字化三维模型在子宫动脉栓塞术(UAE)入路规划中的应用.方法基于CTA检查获取1例子宫肌瘤患者的原始二维断层图像数据集,利用Mimics 10.01软件分别对在体骨盆、腹盆腔动脉血管网进行三维重建并配准融合,测量各级动脉长度、分叉角度及相对位置,并进行UAE术前的入路规划.结果本研究构建的在体骨盆及腹盆腔动脉血管网数字化三维模型可以清楚地显示腹主动脉、双侧髂总动脉、左右髂外动脉、左右髂内动脉及其多级分支.右侧子宫动脉在臀下动脉开口以下15.91 mm处发出,左侧子宫动脉在臀下动脉开口以下15.21 mm处发出,均与膀胱上动脉及阴部内动脉相邻.同时,能精确测量各级动脉的长度及分叉角度,腹主动脉分叉位于第5腰椎体上缘,角度为66.58°；右侧髂内、外动脉分叉角度为46.23°,右侧髂总动脉长度为51.43 mm;左侧髂内、外动脉分叉角度为36.45°,左侧髂总动脉长度为67.50 mm.根据术前的入路规划,导丝越过臀下动脉至其下方15.00 mm处旋转数字减影血管造影术(DSA)球管,可以较清楚地显示子宫动脉开口向外,转动导丝,比较容易进入子宫动脉.结论基于CTA数据集,利用三维重建软件,可以构建出符合临床要求的在体骨盆及腹盆腔动脉血管网数字化三维模型,为子宫动脉介入手术前的入路规划提供依据.
목적 탐토이용CT혈관성상술(CTA)원시수거집구건적재체골분급복분강동맥혈관망수자화삼유모형재자궁동맥전새술(UAE)입로규화중적응용.방법 기우CTA검사획취1례자궁기류환자적원시이유단층도상수거집,이용Mimics 10.01연건분별대재체골분、복분강동맥혈관망진행삼유중건병배준융합,측량각급동맥장도、분차각도급상대위치,병진행UAE술전적입로규화.결과 본연구구건적재체골분급복분강동맥혈관망수자화삼유모형가이청초지현시복주동맥、쌍측가총동맥、좌우가외동맥、좌우가내동맥급기다급분지.우측자궁동맥재둔하동맥개구이하15.91 mm처발출,좌측자궁동맥재둔하동맥개구이하15.21 mm처발출,균여방광상동맥급음부내동맥상린.동시,능정학측량각급동맥적장도급분차각도,복주동맥분차위우제5요추체상연,각도위66.58°；우측가내、외동맥분차각도위46.23°,우측가총동맥장도위51.43 mm;좌측가내、외동맥분차각도위36.45°,좌측가총동맥장도위67.50 mm.근거술전적입로규화,도사월과둔하동맥지기하방15.00 mm처선전수자감영혈관조영술(DSA)구관,가이교청초지현시자궁동맥개구향외,전동도사,비교용역진입자궁동맥.결론 기우CTA수거집,이용삼유중건연건,가이구건출부합림상요구적재체골분급복분강동맥혈관망수자화삼유모형,위자궁동맥개입수술전적입로규화제공의거.
Objective To investigate the construction and significance of in vivo pelvis and abdominal-pelvic arterial vascular network in digital three-dimensional (3D) model for uterine artery embolization (UAE) in the application of surgical approach planning based on computerized tomographic angiography(CTA).Methods A series of digital imaging and communications in medicine 3.0 (Dicom 3.0) were obtained from a woman with myoma of uterus by CTA scanning.Then the software Mimics Version 10.01 was used to construct the pelvic and the arterial vascular network 3D model.Results The digital model could clearly display the abdominal aorta,bilateral common iliac arteries,left and right external iliac artery,internal iliac artery and its branches around the stage ; the right uterine artery emitted in the inferior gluteal artery opening below 15.91 mm,the left uterine artery in inferior gluteal artery below the opening of 15.21 mm,the adjacent artery of internal pudendal artery.At the same time,the artery length and angle of bifurcation were accurately measured.The bifurcation angle of abdominal aorta in fifth lumbar vertebral body edge,was 66.58°,the bifurcation angle of right internal iliac artery was 46.23°,the length of right common iliac artery was 51.43 mm,the bifurcation angle between left and external internal iliac artery was 36.45°,the length of left common iliac artery and 67.50 mm.According to the preoperative approach planning,guided wire across the inferior gluteal artery to the lower 15.00 mm and rotating digital subtraction angiography(DSA) tube,could clearly display the uterine artery opening outward by rotating guide wire,which was relatively easy to enter the uterine artery.Conclusion The female pelvic arterial network model in vivo could be successfully constructed by using Mimics Version 10.01 software with database collected through CTA,which may contribute to the materialization of digital models and be used for preoperative surgical simulator.