MSCTA对活体右叶供肝血管变异分型的研究  

Multi-slice CT Angiography in the Classification of Hepatic Vessel Variations in Right Hepatic Lobe Donor in Vivo for Liver Transplantation

作　　者：庄治国[1] 钱黎俊[1] 汪笔雄[1] 许建荣[1] 

机构地区：[1]上海交通大学医学院附属仁济医院放射科,200127

出　　处：《放射学实践》2009年第7期750-754,共5页Radiologic Practice

基　　金：上海市重点学科建设资助项目(S30203);上海交通大学医学院重点学科第三期资助项目

摘　　要：目的:探讨活体肝移植术前多层螺旋CT血管成像对潜在供肝血管系统评估的临床运用及价值。方法:对连续108例潜在右半肝供体行3期CT增强扫描(动脉期、门静脉期和肝静脉期)。根据所有原始图像和重组图像进行供肝的血管变异分型,肝动脉、门静脉以及肝静脉系统分别进行Michels分型、Akgul分型及Nakamura分型。对其中45例行右半肝切除的供体的肝血管变异分型与术中发现进行比较。结果:108例潜在供体的肝动脉、门静脉和肝静脉系统在MSCT上均显示清晰。根据肝动脉Michels分型,Ⅰ型有64例(59.3%),Ⅱ型9例(8.3%),Ⅲ型13例(12.0%),Ⅳ型4例(3.7%),Ⅴ型11例(10.2%),Ⅵ型3例(2.8%),Ⅷ型和Ⅸ型各2例(1.9%)。根据门静脉Akgul分型,A型有87例(80.6%),B型有15例(13.9%),C型4例(3.7%),E型3例(2.8%)。根据肝静脉Nakamura分型,Ⅰ型有73例(67.6%),Ⅱ型24例(22.2%),Ⅲ型11例(10.2%)。45例进行手术的供体的术前CT血管分型结果与术中发现一致。结论:多层螺旋CT血管成像可良好地显示潜在供肝的血管系统,对活体肝移植术具有重要的临床应用价值。Objective：To discuss the clinical application and its value of multi-row detector CT angiography （MDCTA） in the evaluation of hepatic vessel anatomy of potential liver donors in vivo for liver transplantation （LDLT）. Methods： One hundred and eight consecutive potential right lobe donors in vivo underwent tri-phasic CT angiography （arterial, portal, and hepatic venous phases）. All source and reconstructed images were evaluated for hepatic vasculature anatomy. The anatomic variations of arterial system,portal venous system,and hepatic veins were classified according to Michels system, Akgul system and Nakamura system respectively. In 45 donors with right hepatic hemi-lobectomy,the CT and surgery findings were compared. Results： Hepatic arteries and veins, portal veins in all 108 potential donors were revealed clearly on MDCTA. According to the Michels classification for hepatic artery, there were type Ⅰ （n = 64,59.3%） ; type Ⅱ （n =9, 8.3%）;type Ⅲ （n=13,12.0%）;type Ⅳ （n=4,3.7%）;type Ⅴ （n=11,10.2%）;type Ⅵ （n=3,2.8%）;type Ⅶ （n=2, 1.9%）;and type Ⅸ （n=2,1. 9%）. According to the akgul classification for portal vein, there were type A （n=87, 80.6 % ） ; type B （n = 15,13.9% ） ; type C （n =4,3.7% ） ; and type E （ n= 3,2.8%）. According to the Nakamura classification for hepatic vein,there were type 1 （n=73,67.60%） ;type 2 （n=24,22.2%） and type 3 （n=11,10.2%）. CT angiography findings were in accordance with the surgery in all 45 donors. Conclusion： MDCTA can successfully show the：hepatic vascular anatomy in potential liver donors in vivo,which plays an important role in the clinical application＇ of LDLT.

关 键 词：活体肝移植 体层摄影术 X线计算机 血管成像 分型 

分 类 号：R657.3[医药卫生—外科学]