64排螺旋CT血管成像评价肝静脉解剖三维方位及变异  

The anatomy and variations of the hepatic vein by 64-multisection helical computed topographic angiography

作　　者：赵静[1] 杨广奇[2] 沈静娴[1] 杨栋[2] 郑可国[2] 李子平[2] 

机构地区：[1]中山大学肿瘤防治中心影像与微创介入中心,广州510060 [2]中山大学附属第一医院放射科

出　　处：《中华消化病与影像杂志（电子版）》2013年第2期19-23,共5页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的利用64排螺旋CT血管成像技术,探讨生理状态下相对正常人肝静脉的解剖三维空间定位和重要变异。方法经知情同意下自愿做上腹部增强扫描的患者,按照纳入标准与排除标准,前瞻性分析100例患者CT资料。方法 64排螺旋CT,先行上腹部常规CT平扫,扫描范围自膈顶至肝下缘,再行肝动脉期、门静脉、静脉期三期增强扫描。对肝静脉图像进行后处理,利用多平面重组、最大密度投影及容积重建后处理技术观察肝静脉的解剖分型,并对肝静脉三维空间方位定量分析。运用SAS8.1统计软件包对所得数据进行统计分析。结果肝静脉分型:肝左静脉及肝中静脉共干汇入下腔静脉的有85例(占85%);三支主肝静脉单独汇入下腔静脉的有14例(占14%);有1例患者肝右静脉缺如,有两支粗大的肝右后静脉。按照Nakamura分型,A型64例(占64%);B型30例(占30%);C型6例(占6%)。三大主肝静脉及粗大肝右后静脉三维空间方位及解剖数据,肝右静脉的空间方位是(44.65°,-12.83°,44.11°),肝中静脉的空间方位是(48.65°,37.47°,38.82°),肝左静脉空间方位是(58.33°,112.57°,29.78°)。肝右静脉起始宽度为(10.30±2.58)mm,主干长度(101.55±23.15)mm;肝中静脉起始宽度为(9.10±1.34)mm,主干长度为(94.21±18.65)mm;肝左静脉起始宽度为(8.30±1.05)mm,主干长度为(69.88±13.84)mm。结论通过对肝静脉血管重建图像进行研究,得出了生理状态下相对正常肝静脉的解剖分型及重要变异,为肝脏外科手术提供更准确的信息。Objective To analyze the anatomy and variations of hepatic vein and portal vein in normal Chinese by 64-muhisection helical computed topographic angiography （MSCT）. Methods 100 patients underwent upper abdominal CT scan, who were all in accordance with the inclusion criteria. All studies were performed on MSCT. Firstly, the routine upper abdominal plain CT scan was done and the scan range was from the top of the diaphragm to the inferior border of liver. Secondly, three enhanced phases （arterial phase, portal vein phase and hepatic vein phase） were done. The last, the hepatic vein data were delivered to the work station for MIP, MPR and VR reconstruction. SAS 8.1 soft package was used to do statistical analysis. Results The types of hepatic vein： the rate of MHV and LHV common trunk was 85% ; the three hepatic veins which join the IVC separately was 14% ; 1 patient had two large PRHVs, but without RHV. According to Nakamura classification： Type A, 64%; Type B, 30%; Type C, 6%. The spatial orientation and the specific anatomy data of the three main hepatic veins and posterior right hepatic vein were shown below. The dimensional orientations of RHV, MHV and LHV were 44.65°, -12.83°, 44.11°; 48. 65°, 37.47°, 38.82°; 58.33°, 112.57°, 29.78° respectively. The initial width and the trunk length of RHV, MHV and LHV were （ 10.30 ± 2.58） mm, （ 101.55 ± 23.15 ） mm; （9.10 ± 1.34） mm, （94.21 ± 18.65） mm; （8.30 ± 1.05） mm, （69.88 ± 13.84） mm. Conclusions Through the angiographic reconstructed images of the hepatic vein, the normal anatomical features and variation types of hepatic veins obtained by the angiographic reconstructed images can supply more reliable information for hepatic surgery.

关 键 词：肝静脉 体层摄影术 X线计算机 解剖方位及变异 

分 类 号：R657.3[医药卫生—外科学]