第四章經(jīng)導(dǎo)管血管栓塞術(shù)余開(kāi)湖教授第四章1概念在影設(shè)備四下管向靶血或入栓預(yù)期療目●特點(diǎn)微創(chuàng)性準(zhǔn)確性可控性概念在影設(shè)備四下管向靶血2TAE的治療機(jī)制阻塞靶血管使腫瘤或靶器官造成缺血壞死阻塞或破壞異常血管床腔隙和通道使血液動(dòng)力學(xué)恢復(fù)正常阻塞血管使之遠(yuǎn)端壓力下降或直接從血管內(nèi)封堵破裂的血管以利于止血TAE的治療機(jī)制3對(duì)靶血管的影響栓塞范圍主干小動(dòng)脈末梢栓塞劑性質(zhì)固體液體血管再通影響因素栓塞劑是否可被吸收栓塞劑對(duì)靶血管是否造成嚴(yán)重傷害栓塞的靶血管為終末血管不易再通靶器官栓塞后大部壞死血管難再通對(duì)靶血管的影響4對(duì)靶器官的影響靶器官缺血壞死程度血供栓塞劑性質(zhì)靶器官狀況耐受力栓塞水平指栓塞劑到達(dá)或閉塞血管的位置栓塞程度指靶血管和/或所屬分支閉塞的比例對(duì)靶器官的影響5對(duì)局部血流動(dòng)力學(xué)的影響局部血供改變●栓塞后血液重分布糾正異常的血流動(dòng)力學(xué)●止血作用對(duì)局部血流動(dòng)力學(xué)的影響6器材及栓塞物質(zhì)●器材導(dǎo)管超滑導(dǎo)管微導(dǎo)管2.8~3F導(dǎo)絲超滑導(dǎo)絲超硬導(dǎo)絲器材及栓塞物質(zhì)7栓塞物質(zhì)指用于經(jīng)導(dǎo)管注入并達(dá)到血管栓塞的材料要求能通過(guò)導(dǎo)管注入或送入血管內(nèi)無(wú)毒無(wú)抗原性人體組織相容性良好無(wú)致畸和致癌性能在透視下顯影具有各種規(guī)格,以能栓塞粗細(xì)不同的血管不在人體內(nèi)分解并進(jìn)入血液循環(huán)栓塞物質(zhì)指用于經(jīng)導(dǎo)管注入并達(dá)到血管栓塞的材料8分類(lèi)●效應(yīng)時(shí)間短期中期長(zhǎng)期性質(zhì)固態(tài)液態(tài)●栓塞血管直徑大中小分類(lèi)9常用栓塞劑及其特點(diǎn)短期自體血凝塊制備導(dǎo)管抽出血液10~20m置于消毒器皿內(nèi)自凝或加入凝血酶100~200u根據(jù)需要切成小條塊混合于造影劑中注入特點(diǎn)便于制無(wú)菌無(wú)抗原性栓塞時(shí)間24~48h最多達(dá)2周但松軟易碎不保持塊狀僅用于外傷或潰瘍出血常用栓塞劑及其特點(diǎn)10經(jīng)導(dǎo)管血管栓塞術(shù)課件11經(jīng)導(dǎo)管血管栓塞術(shù)課件12經(jīng)導(dǎo)管血管栓塞術(shù)課件13經(jīng)導(dǎo)管血管栓塞術(shù)課件14經(jīng)導(dǎo)管血管栓塞術(shù)課件15經(jīng)導(dǎo)管血管栓塞術(shù)課件16經(jīng)導(dǎo)管血管栓塞術(shù)課件17經(jīng)導(dǎo)管血管栓塞術(shù)課件18經(jīng)導(dǎo)管血管栓塞術(shù)課件19經(jīng)導(dǎo)管血管栓塞術(shù)課件20經(jīng)導(dǎo)管血管栓塞術(shù)課件21經(jīng)導(dǎo)管血管栓塞術(shù)課件22經(jīng)導(dǎo)管血管栓塞術(shù)課件23經(jīng)導(dǎo)管血管栓塞術(shù)課件24經(jīng)導(dǎo)管血管栓塞術(shù)課件25經(jīng)導(dǎo)管血管栓塞術(shù)課件26經(jīng)導(dǎo)管血管栓塞術(shù)課件27經(jīng)導(dǎo)管血管栓塞術(shù)課件28經(jīng)導(dǎo)管血管栓塞術(shù)課件29經(jīng)導(dǎo)管血管栓塞術(shù)課件30經(jīng)導(dǎo)管血管栓塞術(shù)課件31經(jīng)導(dǎo)管血管栓塞術(shù)課件32經(jīng)導(dǎo)管血管栓塞術(shù)課件33經(jīng)導(dǎo)管血管栓塞術(shù)課件34經(jīng)導(dǎo)管血管栓塞術(shù)課件35經(jīng)導(dǎo)管血管栓塞術(shù)課件36經(jīng)導(dǎo)管血管栓塞術(shù)課件37經(jīng)導(dǎo)管血管栓塞術(shù)課件38經(jīng)導(dǎo)管血管栓塞術(shù)課件39經(jīng)導(dǎo)管血管栓塞術(shù)課件40經(jīng)導(dǎo)管血管栓塞術(shù)課件41經(jīng)導(dǎo)管血管栓塞術(shù)課件42經(jīng)導(dǎo)管血管栓塞術(shù)課件43經(jīng)導(dǎo)管血管栓塞術(shù)課件44經(jīng)導(dǎo)管血管栓塞術(shù)課件45經(jīng)導(dǎo)管血管栓塞術(shù)課件46經(jīng)導(dǎo)管血管栓塞術(shù)課件47經(jīng)導(dǎo)管血管栓塞術(shù)課件48經(jīng)導(dǎo)管血管栓塞術(shù)課件49經(jīng)導(dǎo)管血管栓塞術(shù)課件50經(jīng)導(dǎo)管血管栓塞術(shù)課件51經(jīng)導(dǎo)管血管栓塞術(shù)課件52經(jīng)導(dǎo)管血管栓塞術(shù)課件53經(jīng)導(dǎo)管血管栓塞術(shù)課件54經(jīng)導(dǎo)管血管栓塞術(shù)課件55經(jīng)導(dǎo)管血管栓塞術(shù)課件56經(jīng)導(dǎo)管血管栓塞術(shù)課件57經(jīng)導(dǎo)管血管栓塞術(shù)課件58經(jīng)導(dǎo)管血管栓塞術(shù)課件59經(jīng)導(dǎo)管血管栓塞術(shù)課件60經(jīng)導(dǎo)管血管栓塞術(shù)課件61經(jīng)導(dǎo)管血管栓塞術(shù)課件62經(jīng)導(dǎo)管血管栓塞術(shù)課件63經(jīng)導(dǎo)管血管栓塞術(shù)課件64經(jīng)導(dǎo)管血管栓塞術(shù)課件65經(jīng)導(dǎo)管血管栓塞術(shù)課件66經(jīng)導(dǎo)管血管栓塞術(shù)課件67經(jīng)導(dǎo)管血管栓塞術(shù)課件68經(jīng)導(dǎo)管血管栓塞術(shù)課件69經(jīng)導(dǎo)管血管栓塞術(shù)課件70經(jīng)導(dǎo)管血管栓塞術(shù)課件71經(jīng)導(dǎo)管血管栓塞術(shù)課件72經(jīng)導(dǎo)管血管栓塞術(shù)課件73經(jīng)導(dǎo)管血管栓塞術(shù)課件74經(jīng)導(dǎo)管血管栓塞術(shù)課件75經(jīng)導(dǎo)管血管栓塞術(shù)課件76經(jīng)導(dǎo)管血管栓塞術(shù)課件77經(jīng)導(dǎo)管血管栓塞術(shù)課件78經(jīng)導(dǎo)管血管栓塞術(shù)課件79經(jīng)導(dǎo)管血管栓塞術(shù)課件80經(jīng)導(dǎo)管血管栓塞術(shù)課件81經(jīng)導(dǎo)管血管栓塞術(shù)課件82經(jīng)導(dǎo)管血管栓塞術(shù)課件83經(jīng)導(dǎo)管血管栓塞術(shù)課件84經(jīng)導(dǎo)管血管栓塞術(shù)課件85經(jīng)導(dǎo)管血管栓塞術(shù)課件86經(jīng)導(dǎo)管血管栓塞術(shù)課件87經(jīng)導(dǎo)管血管栓塞術(shù)課件88經(jīng)導(dǎo)管血管栓塞術(shù)課件89經(jīng)導(dǎo)管血管栓塞術(shù)課件90第四章經(jīng)導(dǎo)管血管栓塞術(shù)余開(kāi)湖教授第四章91概念在影設(shè)備四下管向靶血或入栓預(yù)期療目●特點(diǎn)微創(chuàng)性準(zhǔn)確性可控性概念在影設(shè)備四下管向靶血92TAE的治療機(jī)制阻塞靶血管使腫瘤或靶器官造成缺血壞死阻塞或破壞異常血管床腔隙和通道使血液動(dòng)力學(xué)恢復(fù)正常阻塞血管使之遠(yuǎn)端壓力下降或直接從血管內(nèi)封堵破裂的血管以利于止血TAE的治療機(jī)制93對(duì)靶血管的影響栓塞范圍主干小動(dòng)脈末梢栓塞劑性質(zhì)固體液體血管再通影響因素栓塞劑是否可被吸收栓塞劑對(duì)靶血管是否造成嚴(yán)重傷害栓塞的靶血管為終末血管不易再通靶器官栓塞后大部壞死血管難再通對(duì)靶血管的影響94對(duì)靶器官的影響靶器官缺血壞死程度血供栓塞劑性質(zhì)靶器官狀況耐受力栓塞水平指栓塞劑到達(dá)或閉塞血管的位置栓塞程度指靶血管和/或所屬分支閉塞的比例對(duì)靶器官的影響95對(duì)局部血流動(dòng)力學(xué)的影響局部血供改變●栓塞后血液重分布糾正異常的血流動(dòng)力學(xué)●止血作用對(duì)局部血流動(dòng)力學(xué)的影響96器材及栓塞物質(zhì)●器材導(dǎo)管超滑導(dǎo)管微導(dǎo)管2.8~3F導(dǎo)絲超滑導(dǎo)絲超硬導(dǎo)絲器材及栓塞物質(zhì)97栓塞物質(zhì)指用于經(jīng)導(dǎo)管注入并達(dá)到血管栓塞的材料要求能通過(guò)導(dǎo)管注入或送入血管內(nèi)無(wú)毒無(wú)抗原性人體組織相容性良好無(wú)致畸和致癌性能在透視下顯影具有各種規(guī)格,以能栓塞粗細(xì)不同的血管不在人體內(nèi)分解并進(jìn)入血液循環(huán)栓塞物質(zhì)指用于經(jīng)導(dǎo)管注入并達(dá)到血管栓塞的材料98分類(lèi)●效應(yīng)時(shí)間短期中期長(zhǎng)期性質(zhì)固態(tài)液態(tài)●栓塞血管直徑大中小分類(lèi)99常用栓塞劑及其特點(diǎn)短期自體血凝塊制備導(dǎo)管抽出血液10~20m置于消毒器皿內(nèi)自凝或加入凝血酶100~200u根據(jù)需要切成小條塊混合于造影劑中注入特點(diǎn)便于制無(wú)菌無(wú)抗原性栓塞時(shí)間24~48h最多達(dá)2周但松軟易碎不保持塊狀僅用于外傷或潰瘍出血常用栓塞劑及其特點(diǎn)100經(jīng)導(dǎo)管血管栓塞術(shù)課件101經(jīng)導(dǎo)管血管栓塞術(shù)課件102經(jīng)導(dǎo)管血管栓塞術(shù)課件103經(jīng)導(dǎo)管血管栓塞術(shù)課件104經(jīng)導(dǎo)管血管栓塞術(shù)課件105經(jīng)導(dǎo)管血管栓塞術(shù)課件106經(jīng)導(dǎo)管血管栓塞術(shù)課件107經(jīng)導(dǎo)管血管栓塞術(shù)課件108經(jīng)導(dǎo)管血管栓塞術(shù)課件109經(jīng)導(dǎo)管血管栓塞術(shù)課件110經(jīng)導(dǎo)管血管栓塞術(shù)課件111經(jīng)導(dǎo)管血管栓塞術(shù)課件112經(jīng)導(dǎo)管血管栓塞術(shù)課件113經(jīng)導(dǎo)管血管栓塞術(shù)課件114經(jīng)導(dǎo)管血管栓塞術(shù)課件115經(jīng)導(dǎo)管血管栓塞術(shù)課件116經(jīng)導(dǎo)管血管栓塞術(shù)課件117經(jīng)導(dǎo)管血管栓塞術(shù)課件118經(jī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