1.介入放射学总论1【PPT】 .ppt

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1、介入放射学介入放射学定义定义 l 是以影像诊断为基础，在医学影像诊断设备的引导下，利用穿刺针、导管及其他介入器材，对疾病进行治疗或采集组织学、细菌学及生理、生化资料进行诊断的学科l 在影像设备导引下，利用微创的手段对疾病进行诊断和治疗的学科。是继内科学、外科学之后的第三医学The history of interventional radiologylThe history of interventional radiology is a fascinating迷人的 look at innovative 创新的 pioneers who changed the delivery of med

2、icine and greatly improved the quality of patients lives.lThe improved ability of radiologists to see inside the body gave rise to 引起,使发生,导致interventional radiology(IR)-minimally invasive targeted treatments performed under guided imaging-in the mid-1970s.l Interventional radiology procedures are a

3、major advance in medicine that do not require large incision 切口 and offer less risk,less pain and shorter recovery times compared to surgery.The history of interventional radiologylInterventional radiologists invented angioplasty and the first catheter-delivered stent,state of the art treatments tha

4、t are common place in medicine today.lInterventional radiology is a medical specialty recognized by the American Board of Medical Specialties and the American Medical Association.介入放射学发展史介入放射学发展史 20世纪上半叶科学家的探索创新为今后的介入放射学世纪上半叶科学家的探索创新为今后的介入放射学发展奠定了良好坚实的基础发展奠定了良好坚实的基础l1928年Santos等完成第一例经皮直接穿刺主动脉造影l1929

5、 Werner Forsmann:自体右心导管插管自体右心导管插管l1931年Dos Stantos首先用针穿刺腹主动脉完成了最早的动脉造影l1940年古巴放射学家Farinas用股动脉切开的方法将导管送入主动脉，但是此方法由于操作繁杂并未被推广Werner Forssman catheterized his own heart in 1929 to prove catheterization could be doneDr.Werner Forssman lHe placed a ureteral catheter into a vein in his arm,advanced it to

6、the right atrium of his heart,and walked upstairs to the x-ray department where he took the confirmatory x-ray film.lIn 1956,Dr.Werner Forssman was awarded The Nobel PrizeDr.Werner Forssman介入放射学发展史介入放射学发展史l20世纪40年代根据Cournand及Richards的经验开展了右心房、室及肺动脉的导管技术The Nobel Prize in Physiology or Medicine 1956l

7、Andr Frdric Cournand Columbia University Division,Cardio-Pulmonary Laboratory,Bellevue Hospital New York,NY,USA .1/3 of the prize lWerner Forssmann Mainz University Mainz,Federal Republic of Germany;Bad Kreuznach,Federal Republic of Germany.1/3 of the prize lDickinson W.Richards Columbia University

8、New York,NY,USA .1/3 of the prize lfor their discoveries concerning heart catheterization and pathological changes in the circulatory systeml20世纪40年代后期，瑞典学者Jonsson首先用经皮穿刺颈总动脉后，将细针芯抽出，通过外套管送入细银线，通过细银线作引导将外套针向下送至主动脉弓，行血管造影Seldinger TechniquelSeldinger技术的出现，血管造影术血管造影术这一介入放射学的基本操作才由缓慢的步伐转向迅速的发展l1953年年瑞典

9、Sven-Ivar Seldinger医师首创了用套管针、导丝和导管经皮股动脉插管作血管造影的方法，大大简化并提高了介入放射学操作的安全性，为当代介入放射学奠定了基础l应用初期，因为一些临床医师对其可行性持怀疑态度两发展缓慢l20世纪50年代中期至60年代，Seldinger技术开始被应用于许多器官，如：经皮、经肝胆管造影、经皮肾盂、输尿管造影等l北美放射学会因此而授予Seldinger荣誉会员称号Sven Ivar Seldinger Catheter Replacement of the Needle in Percutanous AngiographySven Ivar Seldinge

10、r Sven Ivar SeldingerSven Ivar SeldingerlDr.Seldinger pioneered in applying his technique to the localization of tumors by arteriography,selective renal angiography,percutaneous transhepatic cholangiography,and portal venography.l The simplicity of the Seldinger technique which continues to revoluti

11、onize cardiology and radiology has provided the catalyst 催化剂催化剂 for innovative application in the areas of interventional radiology,urology,anesthesiology and critical care medicine.介入放射学发展史介入放射学发展史l1956年Oedman、Morino与Tillander等分别提出用导管作选择性插管术，使插管造影术逐渐成熟l20世纪70年代至80年代期间：介入放射学使用的器材得到了迅速的发展和极大的改善、从而大大促

12、进了经皮穿刺技术的应用和发展l高分辨率影像增强器和高分辨率影像增强器和DSA技术的普及技术的普及，全身各部位的血管造影以及血管腔内介入疗法，因其侵袭程度小，治疗效果显著，而在世界各国广泛迅速地开展起来Charles Theodore Dotter:The Father of 血血管管成成形形术术-周围动脉成形术P PT TA A术术后后4 4月月股浅动脉粥样硬化-局限性狭窄1964.1.16 1st PTA on a women of 83lCharles Theodore Dotter(1920-1985),was born in Boston,Massachusetts.He studie

13、d medicine and radiology at Cornell University,where he served in a staff position from 1950 to 1952.He then served as Professor and Chairman of Radiology at the University of Oregon Medical School for 33 years until his death.lDr.Dotter altered the course of cardiovascular radiology and is consider

14、ed the father of interventional radiology.He began modifying the Seldinger technique for therapeutic purposes.lThis first therapeutic use of the Seldinger technique quietly started a medical revolution:simultaneous diagnostic and therapeutic procedures reduced the number of surgical beds needed,pati

15、ent risk and the length of patient stay.l Costly and traumatic surgical procedures were eliminated in many cases.These benefits proliferated 增生扩散as the technique extended into other areas of medicine.介入放射学发展史介入放射学发展史l1967年Margulis在美国放射学杂志AJR上最早提出“Interventional diagnostic radiology-a new subspeciali

16、ty”lAlexander R.Margulis.“Interventional diagnostic radiology-a new subspeciality”，Am.J.Roentgenol.Mar 1967;99:763-765.Curriculum vitaelAlexander R.Margulis,Professor of Radiology lAffiliationWeill Medical College,Cornell University,New Yorkl Date of birth31 March 1921 lCountryUSA lPositionClinical Professor of Radiology lEducationHarvard Medical School,MD 1950:Internship:Henry Ford HospitalDetroit,MI;Residency Radiology:Univ.Of Michigan,Ann ArborSeven Honorary Doctorates:Med.College Wisconsin,M