子宫肌瘤数字化三维动脉血管网的构建和意义

摘要

目的 探讨构建基于CTA数据的子宫肌瘤数字化三维动脉血管网的方法,并通过其观察肌瘤的血供来源和血供分布类型.方法 选取子宫肌瘤患者64例行双源CTA扫描,获取CT原始图像后利用Mimics10.01软件对子宫肌瘤动脉血管网进行数字化三维重建,并作分析.结果 (1)构建了64例患者的子宫肌瘤数字化三维动脉血管网,可清晰的显示盆腔大动脉、子宫动脉及肌瘤的主要供血血管和血供分布情况.(2)患者肌瘤的血供来源分别为子宫动脉(81.25%)、子宫动脉和单侧卵巢动脉(10.9%)、子宫动脉和双侧卵巢动脉(4.69%)及卵巢动脉(3.1%).(3)子宫肌瘤血供的分布类型可分为4型:①Ⅰ型:一侧动脉供血为主型(一侧子宫动脉伴/不伴同侧卵巢动脉的供血量显著超过子宫肌瘤瘤体的1/2),占35.9%(23/64);②Ⅱ型:双侧动脉供血均衡型(双侧子宫动脉伴/不伴同侧卵巢动脉的供血量分别约为子宫肌瘤瘤体的1/2),占53.1%(34/64);③Ⅲ型:单纯一侧子宫动脉供血型,占7.8%(5/64);④Ⅳ型:卵巢动脉供血型,占3.1%(2/64).结论 利用CTA和重建软件可以构建出数字化三维的子宫肌瘤动脉血管网,并可进行血供来源及分布的分析,为手术方案的制定和临床教学提供参考.%Objective To discuss the method of constructing digital 3D arterial vascular network of uterine leiomyomas based on the CTA data, by which to lay the fundamental work for the observation of the origin and distribution of hysteromyomas blood supply. Methods A total of 64 cases of uterine leiomyomas were enrolled in this study. Dual-source CT angiography was performed in all the patients, and the CTA original images were obtained. By using MimicslO.Ol software the digital 3D arterial vascular network of uterine was reconstructed. The reconstructed models were analyzed. Results ( 1 ) The constructing process of arterial vascular network was successfully accomplished in all 64 patients. The pelvic main arteries, the uterine arteries and tumor-feeding arteries as well as the blood distribution type were clearly demonstrated on the reconstructed images. (2 ) The origins of hysteromyoma blood supply included uterine artery (81.25% ), uterine artery and unilateral ovarian artery ( 10.94% ), uterine artery and bilateral ovarian artery (4.69% ) and ovarian artery (3.12% ). (3 ) Distribution pattern of blood supply of uterine leiomyomas could be divided into 4 types: ① Type Ⅰ . The unilateral arterial blood supply dominant type ( unilateral uterine artery with or without ipsilateral ovarian arterial, providing more than 1/2 blood supply of hysteromyomas), which accounted for 35.94% of all patients (23/64); ② Type Ⅱ. The bilateral arterial blood supply balanced type (bilateral uterine artery with or without ipsilateral ovarian artery, providing about 1/2 blood supply of hysteromyomas), which accounted for 53.13% of all patients (34/64); ③ Type Ⅲ . The unilateral uterine artery was the main blood supply of uterine leiomyomas, which accounted for 7.81% of all patients (5/64); ④ Type Ⅳ. The ovarian artery was the main blood supply of uterine leiomyomas, which accounted for 3.13% of all patients ( 3/64 ). Conclusion Based on CTA data and with the help of reconstruction software, the digital 3D arterial vascular network of uterine leiomyomas can be successfully established, which can be used to determine the source of the blood supply, to observe the blood distribution of hysteromyomas and to provide useful reference for the making of therapeutic plan and for the teaching in clinical practice.