CAJ | 학술논문

目的：利用 CTA 与 DSA 技术,采用骶髂垂直分段定位法探讨剖宫产术后子宫瘢痕妊娠(CSP)患者子宫动脉开口位置与骨性解剖标志的关系。方法回顾性分析2013年10月—2014年6月浙江大学医学院附属妇产科医院收治的91例 CSP 患者的临床资料和 CTA、DSA 影像学资料。患者年龄23~44岁,平均(32.7±4.2)岁。在骶髂关节骶骨面中,以骶骨的最高点(如左侧 A 点)与髂骨左右两侧的最低点(a、b)为骨盆骨性解剖标志。采用骶髂垂直分段定位法连接 a、b 两点做一水平线 ab,从 A 点向 ab 水平线做一垂线,交点为 D 点,B、C 等分 AD,将骶髂垂直等分为 AB、BC、CD 和 D点远端4段,在患者 CTA 与 DSA 图片上,观察统计患者双侧子宫动脉开口位置在各段的分布情况。结果91例182支子宫动脉中,3支子宫动脉已结扎,CTA 与 DSA 均未见其显示；179支子宫动脉显影,子宫动脉开口位置左侧低于右侧,左侧在 AB、BC、CD 及 D 点远端的比例为0%(0)、3.3%(3/90)、70.0%(63/90)及26.7%(24/90),右侧的比例为0%(0)、11.2%(10/89)、85.4%(76/89)及3.4%(3/89),左右两侧均以 CD 段所占比例最多,两侧在各段分布构成情况差异有统计学意义(χ2=22.618,P <0.01)。结论 CSP 患者子宫动脉开口位置在骶髂各段中分布具有一定的特征,当 CSP患者子宫动脉栓塞治疗无法准确判断子宫动脉开口位置时,利用骶髂垂直分段定位法可为介入治疗提供新的影像学指导和参考。
목적：이용 CTA 여 DSA 기술,채용저가수직분단정위법탐토부궁산술후자궁반흔임신(CSP)환자자궁동맥개구위치여골성해부표지적관계。방법회고성분석2013년10월—2014년6월절강대학의학원부속부산과의원수치적91례 CSP 환자적림상자료화 CTA、DSA 영상학자료。환자년령23~44세,평균(32.7±4.2)세。재저가관절저골면중,이저골적최고점(여좌측 A 점)여가골좌우량측적최저점(a、b)위골분골성해부표지。채용저가수직분단정위법련접 a、b 량점주일수평선 ab,종 A 점향 ab 수평선주일수선,교점위 D 점,B、C 등분 AD,장저가수직등분위 AB、BC、CD 화 D점원단4단,재환자 CTA 여 DSA 도편상,관찰통계환자쌍측자궁동맥개구위치재각단적분포정황。결과91례182지자궁동맥중,3지자궁동맥이결찰,CTA 여 DSA 균미견기현시；179지자궁동맥현영,자궁동맥개구위치좌측저우우측,좌측재 AB、BC、CD 급 D 점원단적비례위0%(0)、3.3%(3/90)、70.0%(63/90)급26.7%(24/90),우측적비례위0%(0)、11.2%(10/89)、85.4%(76/89)급3.4%(3/89),좌우량측균이 CD 단소점비례최다,량측재각단분포구성정황차이유통계학의의(χ2=22.618,P <0.01)。결론 CSP 환자자궁동맥개구위치재저가각단중분포구유일정적특정,당 CSP환자자궁동맥전새치료무법준학판단자궁동맥개구위치시,이용저가수직분단정위법가위개입치료제공신적영상학지도화삼고。
Objective To investigate the anatomical relationship between the uterine artery and the adjacent bony landmarks in cesarean scar pregnancy ( CSP ) with the method of sacroiliac vertical segmentation localization using CT angiography ( CTA ) and digital subtraction angiography ( DSA ). Methods From October 2013 to June 2014, 91 patients of CSP were examined by CTA and DSA in Department of Radiology of the Women′s Hospital of Medicine Zhejiang University. The mean age of the patients was (32. 7 ± 4. 2) years (range from 23 to 44 years). The clinical data and the images of CTA and DSA from 91 patients were retrospectively reviewed. In the sacral side of the sacroiliac joint, the highest point of the sacrum(e. g. the left A point) and the bilateral lowest points of the ilium(point a and b) were defined as the bony landmarks of pelvis. According to the sacroiliac vertical segmentation localization mehtod, we drew a vertical line from point A to line ab which was the horizontal line through point a and b, point D was the intersection of the vertical line and line ab. Point A and B were two equal diversion points of AD line. Then, the vertical line was divided equally into four parts (namely AB, BC, CD and below D point), the distribution of the patients bilateral uterine artery ( UA) orifice site at different parts of the vertical line were observed and analyzed on both CT image and DSA image. Results In the current study, 179 uterine arteries from 91 patients were demonstrated clearly at CTA and DSA, and three UA were ligated without visualized on CTA or DSA. The site of left UA orifice was lower than that of the right UA orifice, the left UA orifice located at AB in 0% (0), at BC in 3. 3% (3 / 90), at CD in 70. 0% (63 / 90), and at below D point in 26. 7% (24 / 90), the right UA orifice located at AB in 0% (0), at BC in 11. 2% (10 /89), at CD in 85. 4% (76 / 89), and at below D point in 3. 4% (3 / 89). The most common site of bilateral UA orifice was at the level of CD, and a significant difference in the distribution of UA orifice was observed between left and right (χ2 = 22. 618, P < 0. 01). Conclusions The distribution of UA orifice has certain characteristics at different parts of the vertical line. Thus, when the origin of UA is difficult to be identified clearly in the patients of CSP treated with uterine artery embolization , the sacroiliac vertical segmentation localization method can provide a new imaging reference and guidance for uterine artery embolization.