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
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DSADSA 操作台操作台
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BB 超超
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BB 超超
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CTCT
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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!