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1、Zhongshan Hospital Fudan University,介入放射学示教,Zhongshan Hospital Fudan University,第一部分,介入放射学简介,Zhongshan Hospital Fudan University,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 University,介入所需的导向设备,最常用的是X线电视透视（D
2、SA） 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 University,DSA,Zhongshan Hospital Fudan University,DSA,Zhongshan Hospital Fudan University,DSA操作台,Zhongshan Hospital Fudan University,B超,Zhongshan Hospital Fudan University,B超,Zhongshan Hospital Fudan University,CT,Zhongshan Hospital Fud
3、an University,CT操作台,Zhongshan Hospital Fudan University,介入常用的器械,穿刺针,Zhongshan Hospital Fudan University,介入常用的器械,导管鞘,Zhongshan Hospital Fudan University,介入常用的器械,导丝,Zhongshan Hospital Fudan University,介入常用的器械,导管,Zhongshan Hospital Fudan University,介入常用的栓塞物质,明胶海绵（固体、短、中期栓塞剂）,Zhongshan Hospital Fudan Un
4、iversity,介入常用的栓塞物质,碘油（液体、长期栓塞剂）,Zhongshan Hospital Fudan University,介入常用的栓塞物质,无水酒精（液体、长期栓塞剂）,Zhongshan Hospital Fudan University,介入常用的栓塞物质,不锈钢圈（固体、长期栓塞剂）,Zhongshan Hospital Fudan University,介入常用的栓塞物质,聚乙烯醇（PVA）（固体、长期栓塞剂）,Zhongshan Hospital Fudan University,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
5、其他改进：导管鞘，微穿刺套装，超声引导技术,Zhongshan Hospital Fudan University,Dr Sven-Ivar Seldinger (1921-1998), a Swedish radiologist from Mora, Dalarna County,Zhongshan Hospital Fudan University,Seldinger法示意图,Zhongshan Hospital Fudan University,Seldinger法示意图,Zhongshan Hospital Fudan University,Seldinger法示意图,Zhongsha
6、n Hospital Fudan University,Seldinger法示意图,Zhongshan Hospital Fudan University,Seldinger法示意图,Zhongshan Hospital Fudan University,Seldinger法示意图,Zhongshan Hospital Fudan University,Seldinger法示意图,Zhongshan Hospital Fudan University,Seldinger法示意图,Zhongshan Hospital Fudan University,Zhongshan Hospital Fud
7、an University,Zhongshan Hospital Fudan University,Zhongshan Hospital Fudan University,Zhongshan Hospital Fudan University,Zhongshan Hospital Fudan University,Zhongshan Hospital Fudan University,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
8、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 University,血管造影,脑血管造影,Zhongshan Hospital Fudan University,血管造影,主动脉弓造影,Zhongshan Hospital Fudan University,血管造影,腹主动脉造影,Zhongshan Hospital Fudan University,血管造影,支气管动脉造影,支气管动脉,Zhongshan Hospital Fudan University,血管造影,肝动
9、脉造影（正常）,Zhongshan Hospital Fudan University,血管造影,肠系膜血管造影,Zhongshan Hospital Fudan University,血管造影,肾动脉造影,Zhongshan Hospital Fudan University,血管造影,髂动脉造影,Zhongshan Hospital Fudan University,血管造影,下肢血管造影,Zhongshan Hospital Fudan University,血管造影,下肢血管造影,Zhongshan Hospital Fudan University,血管造影,下肢血管造影,Zhong
10、shan Hospital Fudan University,血管造影,下腔静脉造影,Zhongshan Hospital Fudan University,胃肠道出血的栓塞,胃冠状静脉栓塞,Zhongshan Hospital Fudan University,血管性疾病的栓塞,肾动脉瘤,Zhongshan Hospital Fudan University,血管性疾病的栓塞,肾动脉瘤,Zhongshan Hospital Fudan University,血管性疾病的栓塞,颈部动静脉畸形,Zhongshan Hospital Fudan University,血管性疾病的栓塞,颈部动静脉畸
11、形,Zhongshan Hospital Fudan University,肿瘤的栓塞治疗,原发性肝癌,介入前,DSA,Zhongshan Hospital Fudan University,肿瘤的栓塞治疗,原发性肝癌,DSA,碘油平片,Zhongshan Hospital Fudan University,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 University,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 University,肿瘤的栓塞治疗,原发性肝癌,介入前
12、,介入后2月,介入后2年,Zhongshan Hospital Fudan University,肿瘤的栓塞治疗,原发性肝癌,Zhongshan Hospital Fudan University,肿瘤的栓塞治疗,原发性肝癌,Zhongshan Hospital Fudan University,肿瘤的栓塞治疗,继发性肝癌,Zhongshan Hospital Fudan University,肿瘤的栓塞治疗,肝血管瘤,Zhongshan Hospital Fudan University,肿瘤的栓塞治疗,肝血管瘤,Zhongshan Hospital Fudan University,肿瘤的
13、栓塞治疗,子宫肌瘤,介入前,介入后,Zhongshan Hospital Fudan University,消除病变器官功能,脾功能亢进、部分脾动脉栓塞,Zhongshan Hospital Fudan University,PTA（经皮血管成形术）,肾动脉PTA,PTA前,PTA,PTA后,（球囊扩张）,Zhongshan Hospital Fudan University,PTA,下肢血管PTA,PTA前,PTA,PTA后,Zhongshan Hospital Fudan University,血管内支架,Zhongshan Hospital Fudan University,血管内支架,
14、颈动脉支架,Zhongshan Hospital Fudan University,血管内支架,主动脉支架,Zhongshan Hospital Fudan University,血管内支架,肾动脉支架,Zhongshan Hospital Fudan University,血管内支架,下肢血管支架,支架前,支架后,支架后,Zhongshan Hospital Fudan University,血管内支架,下腔静脉支架,支架前,支架后,Zhongshan Hospital Fudan University,血管内支架,门静脉支架,PVTT,Zhongshan Hospital Fudan Un
15、iversity,内支架,Tipss分流道支架,Zhongshan Hospital Fudan University,非血管性的介入治疗,食管狭窄的球囊扩张,Zhongshan Hospital Fudan University,非血管性的介入治疗,胃窦部狭窄的支架治疗,Zhongshan Hospital Fudan University,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 University,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 Universi
16、ty,非血管性的介入治疗,胆道内支架,Zhongshan Hospital Fudan University,第二部分,血管造影的基本表现和病例示教,Zhongshan Hospital Fudan University,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 University,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,
