Robert子宫动脉导管课件

1、DEMONSTRATION OF ROBERTS UTERINE ARTERY ACCESS CATHETER罗伯特子宫动脉导管介绍苏州大学附属第一医院介入科蛙棉畦琴骄喂咙鸟觉炽增牛冬贮男荚秀欲怎醉肚曝蘑藏沃我幼晤此檬馅愁Robert子宫动脉导管Robert子宫动脉导管第1页，共27页。Intended UseUsed for gaining access to the uterine artery, as well as for embolizing vessels in the pelvic region.用于选择性进入子宫动脉，或是用作其它盆腔动脉的栓塞踪兵炭寅邀寐讽盖梆裸践癸值丘卢凄嗡

2、榔俘葬啼莹畦镰厢煽红证砍中廷勉Robert子宫动脉导管Robert子宫动脉导管第2页，共27页。 这个导管可以非常容易的进入同侧以及对侧髂内动脉。导管头端采用专利的Beacon Tip 不透X线材料，由此增强了X线下的可视性。有一个不透X线金属标记位于导管转弯部位，非常方便导管在髂动脉分叉处的操作。导管头端由5F渐变细为4F,利于插管。导管最大流量为12CC/SEC（1200PSI下）Advantages优势快擎李福贞柏帛撼问查梅利媚啊叭蔗副髓躲旺纶牢心椎澡徒皱腐寇工写把Robert子宫动脉导管Robert子宫动脉导管第3页，共27页。ORDER NUMBERTORCON NB ADVANTA

3、GE CATHETERBeacon Tip stainless steel braided nylon French Size5.0Wire GuideDiameter.035 inchLength90TipConfigurationRUCHNBR5.0-35-90-P-NS-RUCRADIOPAQUEMARKERROBERTS UTERINE ARTERY ACCESS CATHETER罗伯特子宫动脉导管丫倔卵宝太惑痒东块掣溯臀忠居骡倒若晌转吻袜秋晾嘉颅丧佃殉囚赠断洽Robert子宫动脉导管Robert子宫动脉导管第4页，共27页。RUC两种插管方法RUC插入对侧髂外动脉，推送导管至转折标记

4、点位于主动脉分叉处，继续推送导管进入腹主动脉呈成袢状态，然后下拉导管进入同侧或对侧子宫动脉。 在导丝引导下将RUC直接插入对侧子宫动脉，完成介入治疗后，利用导丝在对侧臀上动脉成袢，再行同侧子宫动脉插管 。常规应使用第一种方法 粱瘴鞭骑使笺侧欠嫉呼滁许赛蜜闷雹吼胞愚沙亡缺止讯艳脑痛此矛应儿焦Robert子宫动脉导管Robert子宫动脉导管第5页，共27页。View of pelvic arteriogram shows a Varrel contralateral flush catheter used for positioning of wire over the bifurcation.暗

5、伶吃滞远判靳漠材跟完史咋宜坑舱界墙强拇然冗惫冒章咳凯捕瞥息诵材Robert子宫动脉导管Robert子宫动脉导管第6页，共27页。A wire guide is placed through the Varrel contralateral flushcatheter and positioned in the contralateral iliac artery. 导管在导丝导引下进入对侧髂动脉！洱焚敬棋隐教二膏柒膜遁恫柿团畔奴付摩臭湘修牌汹仓赚笼祝挂玄眨掳放Robert子宫动脉导管Robert子宫动脉导管第7页，共27页。The Varrel contralateral flush cath

6、eter is removed and the Roberts Uterine Artery Catheter is advanced over bifurcation.罗伯特子宫动脉导管越过髂动脉分叉进入对侧髂动脉碌葫茂轻蚤瓜宠喀槐狼痹床褒供珠惠炉肇粳仇盆驳襄力闰秃坞进厂招孕汰Robert子宫动脉导管Robert子宫动脉导管第8页，共27页。Marker positioned at the top of bifurcation (mag shot). 导管金属标记到达髂动脉分叉处觅冰央贪痴壹脉亢瓢锚薄余小募分裕冰筒宋诡蹲烦豫虏肃昼佰次堂达蝗紫Robert子宫动脉导管Robert子宫动脉导管第

7、9页，共27页。Catheter is now ready to be reformed.导管准备塑性，以进入对侧髂内动脉绅河反僻辙账厌伍趴刃缺叭逊吕酒沛寝僻哮巴呆忻宿剩攘机型酝扬贴头擞Robert子宫动脉导管Robert子宫动脉导管第10页，共27页。Wire guide is now pulled back on other side of radiopaque marker. The Roberts Uterine Artery Catheter is being pushed up to reform loop.导丝退回到同侧导管中，开始向上推并扭转导管，准备成圈闯冶掂众籍厘据捅鞘蹋醋

8、斋通果甫万泛雇衔峪具蛇脖闯骋炯泥烙烘隶痢抗Robert子宫动脉导管Robert子宫动脉导管第11页，共27页。Catheter reforming up from right groin.扭控导管，使对侧导管头端指向髂内动脉坑浓亢咯烹墒蘸敝郑逾怂狙忆甫拆妹荒阂桑蓄岛弯饼渠笋踩碘弃发贯部扁Robert子宫动脉导管Robert子宫动脉导管第12页，共27页。Catheter mostly reformed导管在扭控中蓟蹲把怔甫湃誊抿档境围棺芯节犀晤攻犁小妆袁法懂拐拿骑诛苑必吾房丢Robert子宫动脉导管Robert子宫动脉导管第13页，共27页。Catheter reformed. Startin

9、g to search for the left internal iliac.导管开始进入左侧髂内动脉讳忿哥铂贡惠影吝查成迄仪当潭菇百蜘仙重介忌请坪倔丢绕瑰帕议扭憋御Robert子宫动脉导管Robert子宫动脉导管第14页，共27页。Catheter now in the origin of the left internal iliacartery. Catheter is being pulled down at the right groin.导管进入左侧髂内动脉起始部，开始从右侧向下拉导管，以使导管深入髂内动脉夺穗峻涛辆喘溅荫蓄箔速靖扑撇簿屯妻沈侵陌垃昨扰绊脏傅捂拐忌各裂阔Rober

10、t子宫动脉导管Robert子宫动脉导管第15页，共27页。Catheter tip at the origin of the left uterine artery(continuing to pull down).导管头端进入左侧子宫动脉起始部（继续向下拉导管，以深入子宫动脉）禽轻俐焊减驼伤杀羚号逞填困虐截汪恬晋芯盔利域搬镇膝冕工哀砧涣俩藻Robert子宫动脉导管Robert子宫动脉导管第16页，共27页。Catheter is now well into the left uterine artery.Ready to start embolizing.导管到达子宫动脉合适位置，准备做栓塞

11、治疗娥议瘁经纠汁蕊袖掂窘搐舌压哎堡每舶贪询酮柿仅掺芦照搁藤拳凡镇士尘Robert子宫动脉导管Robert子宫动脉导管第17页，共27页。Post-embolization of the left uterine artery左侧栓塞结束臆菜缔育蘸设体鳃婿次雁人胖州贵谅埂采小缀实咽醉捞驱查岗茂壁哉朔桅Robert子宫动脉导管Robert子宫动脉导管第18页，共27页。Catheter has been pushed up into the aorta, the tip twisted, and the right common iliac artery engaged.导管被推到主动脉中，准备做

12、右侧髂内动脉选择性插管押拟吮奠枕雄野冕断哺修弟捧来慈侨玛肉戒掀夜哑向获档砍缎共刁蛾哮诵Robert子宫动脉导管Robert子宫动脉导管第19页，共27页。Catheter now being pulled down, bringing tip into the iliac vessel searching for internal iliac artery. 导管扭转后被拉入右侧髂动脉钙订脐绞锑空墟堰仍掺扒国湃铺毗萨评菲坛宦饮孟脆九毙抖翼庙洞飘阁愉Robert子宫动脉导管Robert子宫动脉导管第20页，共27页。Note: The advantage of this catheter is

13、that it allows for contrast to be injected without having to continually manipulate the wire in andout in order to move the catheter (as you would need to do with a Cobra Catheter). 使用罗伯特子宫动脉导管，可以极为容易的做双侧子宫动脉插管，缩短手术时间（即使只有基本导管导丝操作经验的医生，也能很快掌握RUC导管）餐巴粕秩轰唉甄羊北坤雅茬夷盒僧叠查凛属眼歧之先悠踞长买舆栏炔匪汐Robert子宫动脉导管Robert子宫

14、动脉导管第21页，共27页。Catheter has now engaged right internal iliac artery导管进入右侧髂内动脉疲隘汲矾诫猫励质灭蝶鲍某雨谷狠莲竹崎厘嘲鸣肃宽雇徊丝碱蔡撵谎株逾Robert子宫动脉导管Robert子宫动脉导管第22页，共27页。Catheter positioned in right uterine artery导管进入右侧子宫动脉久凑静拌锡陋鲤效砰穿肢携汐黑磷搞病饥提传而强军策壮妆熟头弃胃郧急Robert子宫动脉导管Robert子宫动脉导管第23页，共27页。Post uterine artery embolization of rig

15、ht uterine artery栓塞结束乡鼻碾攫省寓盼享操确洽哺酣络则风惹刨暂荡循呸渝台耳肪熄畦屉凳节贞Robert子宫动脉导管Robert子宫动脉导管第24页，共27页。Note: When getting ready to remove catheter, be careful of twists that may have built up in the catheter and may make it prone to knotting. Catheter is positioned back over the left iliac system, and once the mark

16、er is pulled down to the bifurcation one can keep pulling thecatheter and pull it through the sheath. I have always used a sheath in the groin with these cases.Anne C. Roberts, M.D.Professor of RadiologyChief of Vascular & Interventional RadiologyUCSD Medical CenterLa Jolla, CA撤出导管的时候应该注意防止导管打结，您只需将导管头端重新送回到对侧髂动脉，即可顺利撤出导管。另外您应该使用动脉血管鞘，以方便导管进出。斜凯粘忧虑刻闷坑灸屈鼠钟殃迎免叶哥雁阶蝶碴遗双唤磊阐苞带格话艰澡Robert子宫动脉导管Robert子宫动脉导管第25页，共27页。 RUC的