介入放射学示教

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入放射学示教介入放射学示教

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

第一部分第一部分

介入放射学简介

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入放射学介入放射学

• 以影像诊断学为基础 , 并在影像设备的导向下 , 利用经皮穿刺和导管技术等 , 对一些疾病进行非外科手术治疗或者以取得组织学、细菌学、生理和生化材料，以明确病变性质。

• 它又可称为微创手术治疗学。• 分为血管介入和非血管介入。

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入所需的导向设备介入所需的导向设备

最常用的是 X 线电视透视（ DSA ）其次是 B 超、 CT 或 MRI

各种导向设备均有各自的优越性，应合理应用。

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

DSADSA

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

DSADSA

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

DSADSA 操作台操作台

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

BB 超超

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

BB 超超

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

CTCT

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

CTCT 操作台操作台

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入常用的器械介入常用的器械

穿刺针

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入常用的器械介入常用的器械导管鞘

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入常用的器械介入常用的器械

导丝

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入常用的器械介入常用的器械

导管

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入常用的栓塞物质介入常用的栓塞物质

明胶海绵（固体、短、中期栓塞剂）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入常用的栓塞物质介入常用的栓塞物质

碘油（液体、长期栓塞剂）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入常用的栓塞物质介入常用的栓塞物质

无水酒精（液体、长期栓塞剂）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入常用的栓塞物质介入常用的栓塞物质

不锈钢圈（固体、长期栓塞剂）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

介入常用的栓塞物质介入常用的栓塞物质

聚乙烯醇（ PVA ）（固体、长期栓塞剂）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

经皮血管穿刺技术经皮血管穿刺技术

主要步骤：穿刺血管，引入导丝，沿导丝引入导管

技术改进：空芯前壁穿刺

其他改进：导管鞘，微穿刺套装，超声引导技术

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Dr Sven-Ivar Seldinger

(1921-1998), a Swedish

radiologist from Mora, Dalarna

County

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Seldinger法示意图

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Seldinger法示意图

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Seldinger法示意图

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Seldinger法示意图

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Seldinger法示意图

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Seldinger法示意图

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Seldinger法示意图

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Seldinger法示意图

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管穿刺途径包括血管穿刺途径包括 ::股动脉：全身各动脉入路，应用最广泛股静脉：下腔静脉、肺动脉、肾静脉、精索静

脉和肝静脉入路锁骨下静脉：是上腔静脉和肺动脉的入路，用

于肺动脉溶栓，静脉高营养留置导管颈静脉： TIPS 、 DIPS 入路；布加氏综合症

破膜处理；静脉高营养留置导管锁骨下动脉：肝动脉泵置入；主动脉夹层造影；

腹主动脉腔内支架置入术牵引

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影

脑血管造影

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影主动脉弓造影

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影腹主动脉造影

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影

支气管动脉造影支气管动脉

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影

肝动脉造影（正常）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影肠系膜血管造影

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影肾动脉造影

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影髂动脉造影

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影下肢血管造影

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影下肢血管造影

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影下肢血管造影

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管造影血管造影

下腔静脉造影

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

胃肠道出血的栓塞胃肠道出血的栓塞胃冠状静脉栓塞

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管性疾病的栓塞血管性疾病的栓塞肾动脉瘤

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管性疾病的栓塞血管性疾病的栓塞肾动脉瘤

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管性疾病的栓塞血管性疾病的栓塞颈部动－静脉畸形

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管性疾病的栓塞血管性疾病的栓塞颈部动－静脉畸形

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗原发性肝癌

介入前 DSA

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗原发性肝癌

DSA 碘油平片

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗原发性肝癌

介入后 3月

介入后 9月

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗原发性肝癌

介入前介入后 2月

介入后 8月

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗原发性肝癌

介入前介入后 2月 介入后 2

年

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗原发性肝癌

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗

原发性肝癌

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗继发性肝癌

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗肝血管瘤

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗肝血管瘤

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤的栓塞治疗肿瘤的栓塞治疗子宫肌瘤

介入前 介入后

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

消除病变器官功能消除病变器官功能脾功能亢进、部分脾动脉栓塞

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

PTAPTA （经皮血管成形术）（经皮血管成形术）肾动脉 PTA

PTA 前 PTAPTA 后

（球囊扩张）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

PTAPTA下肢血管 PTA

PTA 前PTA

PTA 后

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管内支架血管内支架

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管内支架血管内支架

颈动脉支架

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管内支架血管内支架主动脉支架

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管内支架血管内支架

肾动脉支架

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管内支架血管内支架下肢血管支架

支架前支架后

支架后

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管内支架血管内支架下腔静脉支架

支架前 支架后

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管内支架血管内支架门静脉支架

PVTT

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

内支架内支架Tipss 分流道支架

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

非血管性的介入治疗非血管性的介入治疗

食管狭窄的球囊扩张

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

非血管性的介入治疗非血管性的介入治疗胃窦部狭窄 的支架治疗

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

非血管性的介入治疗非血管性的介入治疗胆道梗阻的经皮穿刺引流（内、外引流）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

非血管性的介入治疗非血管性的介入治疗胆道梗阻的经皮穿刺引流（内、外引流）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

非血管性的介入治疗非血管性的介入治疗胆道内支架

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

第二部分第二部分

血管造影的基本表现和病例示教

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤病变的血管造影基本表现肿瘤病变的血管造影基本表现

供血动脉增粗和血管移位肿瘤染色 tumor staining 和血管湖肿瘤血管 tumor vessel

动门脉瘘或动静脉瘘 arterioportal

shunt

肿瘤血管“包埋征”癌栓“条纹征”

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管性病变的血管造影基本表现血管性病变的血管造影基本表现

血管狭窄 或闭塞

stenosis and occlusion

侧支循环

Collateral branch

动脉瘤或静脉瘤

aneurysm

假性动脉瘤

pseudoaneurysm

动脉夹层dissecting aneurysm

动静脉畸形arteriovenous malformation

动静脉瘘arteriovenous shunt

出血bleeding

血管栓塞及血栓形成embolism and thrombosis

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University血管移位

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University血管狭窄血管狭窄

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肝动脉造影（原发性肝癌） (肿瘤染色）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤染色＋动静脉漏肿瘤染色＋动静脉漏

肝动脉造影（原发性肝癌）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤染色肿瘤染色

肝动脉造影（继发性肝癌）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肿瘤染色和肿瘤血管（子宫肌瘤）

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

血管湖

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肝动门静脉瘘

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

癌栓“条纹征”

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

动静脉畸形

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

肺动－静脉畸形

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

颈动脉海绵窦瘘颈动脉海绵窦瘘carotid cavernous fistula carotid cavernous fistula

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University侧支循环

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University假性动脉瘤

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

动脉夹层

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University动脉瘤

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University血管栓塞

Zhongshan Hospital Fudan UniversityZhongshan Hospital Fudan University

谢 谢！