多层螺旋CT在活体肝右叶移植供体术前肝静脉评估中的应用  

Application of Multi-slice Spiral CT on Donor Selection and Surgical Planning before Living Adult Right Lobe Liver Transplantation

作　　者：雷静[1] 宋光义[1] 韩丹[1] 杨亚英[1] 刘晓明[1] 孙桂芳[1] 

机构地区：[1]昆明医学院第一附属医院CT室,云南昆明650032

出　　处：《实用放射学杂志》2008年第11期1499-1501,1511,共4页Journal of Practical Radiology

摘　　要：目的探讨多层螺旋CT(multi-slice spiral computed tomography,MSCT)在活体肝右叶移植供体术前评估中的应用。方法60例被分为2组,平扫后以100ml对比剂用量,3.5ml/s流率经肘静脉注入对比剂后,分别于70s,75s延迟时间行增强扫描。扫描完成后对运用表面遮盖显示法(SSD),部分加用容积重建法(VR)或最大密度投影法(MIP)对数据进行图像后处理。分析穿过位于肝中静脉(MHV)右侧肝切除面的大静脉;肝右下副静脉的出现、直径及其汇入下腔静脉处与肝右静脉汇入下腔静脉处的距离;分析各组肝中静脉主干CT值、肝中静脉主干与肝实质CT值差值之间的关系。结果60例中,引流第Ⅴ、Ⅷ段的大静脉(直径>5mm)穿过手术切面汇入肝中静脉的有30例(50%);发现22例(36.7%)共25支右下副静脉,3例(5%)有2支右下副静脉;25支中,有14支直径超过5mm;有18支右下副静脉汇入下腔静脉处到肝右静脉汇入下腔静脉处之间的冠状面距离超过40mm。70s组与75s组对肝静脉的显示差异无显著性。结论运用MSCT技术,能模拟肝右叶活体肝移植预期手术切面,清晰显示手术相关的肝静脉变异,解剖类型及走行,为临床选择合适供体,确定安全手术切面提供全面资料。Objective To evaluate the application of multi - slice spiral CT on donor selection and surgical planning before living adult right lobe liver transplantation. Methods Sixty consecutive potential donors were included in this study. Sixty cases were classified into 2 groups which were performed enhanced scanning at 70s, 75s after the initiation of injection at the rate of 3.5ml/s with 100ml contrast material. Postprocessing was performed by a radiologist using postprocessing software of surface shaded display（ SSD ） ,volume rendering（ VR） and maximum intensity projection （ MIP ） were performed in some donor . CT data included hepatic vein anatomy traversing the anticipated surgical hepatectomy plane to the right of the middle hepatic vein（MHV） ,the presence and size of the accessory inferior hepatic vein , and the coronal distance from caval insertion of the accessory inferior hepatic vein to the RHV - caval confluence. CT number of the MHV trunks and the subtraction of the MHV trunks and the hepatic parenchyma were analyzed comparatively between two groups. Results The segment Ⅷ and Ⅴ draining into the MHV in 30 （50%） patients （ the major draining vein was 〉 5 mm in diameter） which traversed the hepatectomy plane. 25 accessory hepatic veins were identified in 22（ 36.7% ）patients, and in these 22 donors, two accessory hepatic veins were seen in 3（5% ） patients. The diameter were larger than 5 rnm in 14 accessory.hepatic veins. The average distance to the RHV - inferior vena cava confluence more than 40 mm were seen in 18 . The image quality of the hepatic veins in the 75s and 70 s group was of not significant difference. Conclusion Multi - slice spiral CT examination can provide most of the necessary preoperative hepatic vein data which are required for surgical planning and donors selection by showing a virtual hepatcctomy plane and the hepatic vein anatomic variations that traverse the hepatectomy plane.

关 键 词：活体肝移植 供体 体层摄影术 X线计算机 

分 类 号：R657.3[医药卫生—外科学] R814.42[医药卫生—临床医学]