基于160例患者CT三维重建的肝血管解剖变异分析  

Analysis of anatomical variation of hepatic vessels based on three-dimensional CT reconstruction in160 patients

作　　者：王建奇[1] 陈政良 刘雨 俞星新 耿志达 姜洪池[1] 梁英健[1] Wang Jianqi;Chen Zhengliang;Liu Yu;Yu Xingxin;Geng Zhida;Jiang Hongchi;Liang Yingjian(Department of Hepatic Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属第一医院肝脏外科,150000

出　　处：《中华肝脏外科手术学电子杂志》2023年第4期427-433,共7页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：黑龙江省博士后科研启动基金(LBH-Z16100,LBH-Q20135)。

摘　　要：目的采用CT三维(3D)重建技术探讨肝血管解剖变异类型和发生率。方法本研究对象为2017年9月至2020年7月在哈尔滨医科大学附属第一医院接受腹部64排增强多层螺旋CT(MSCT)三维重建的160例成人患者。患者均签署知情同意书,符合医学伦理学规定。其中男80例,女80例;年龄27~78岁,中位年龄54岁。将MSCT图像数据导入IQQA系统,创建肝动、静脉的3D重建,模拟目标节段,记录每例肝血管变异的类型和数量。结果肝动脉变异Hiatt分型1型130例,2型11例,3型10例,4型1例,5型1例,6型4例,7型1例,8型2例,9型0例。56.9%(91/160)的肝左静脉为主干型,双干型占30.0%(48/160),放射型占13.1%(21/160)。61.9%(99/160)的肝中静脉为S4段肝静脉汇入肝左静脉,36.9%(59/160)为S4段肝静脉汇入肝中静脉,1.2%(2/160)为S4段肝静脉独立汇入下腔静脉。74.4%(119/160)的肝右静脉为S6段肝静脉主干型,双干型占22.5%(36/160),三干型占3.1%(5/160)。脐裂静脉占比78.8%(126/160),其中53.2%(67/126)的脐裂静脉汇入肝左静脉根部,23.8%(30/126)汇入肝左静脉远端,13.5%(17/126)汇入肝中静脉根部,9.5%(12/126)汇入肝中静脉和肝左静脉之间部分。前裂静脉占比74.4%(119/160),其中94.1%(112/119)的前裂静脉汇入肝中静脉,5.9%(7/119)汇入肝右静脉。结论肝血管解剖变异具有极大的复杂性和偶然性,三维重建技术可指导外科医师选择最佳的手术方法和技术,提高手术安全性。Objective To investigate the type and incidence of anatomical variation of hepatic vessels by using three-dimensional(3D)CT reconstruction.Methods 160 adult patients undergoing abdominal 64-slice enhanced multi-slice spiral CT(MSCT)three-dimensional reconstruction in the First Affiliated Hospital of Harbin Medical University from September,2017 to July,2020 were enrolled in this study.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,80 patients were male and 80 female,aged from 27 to 78 years,with a median age of 54 years.MSCT imaging data were imported into IQQA system to perform 3D reconstruction of hepatic arteries and veins,to simulate the target segment and record the type and quantity of hepatic vascular variation in each patient.Results According to Hiatt classification of hepatic arterial variations,130 cases were classified as HiattⅠ,11 cases of HiattⅡ,10 cases of HiattⅢ,1 case of HiattⅣ,1 case of HiattⅤ,4 cases of HiattⅥ,1 case of HiattⅦ,2 cases of HiattⅧand 0 case of HiattⅨ,respectively.The proportion of left hepatic vein with primary-trunk type was 56.9%(91/160),30.0%(48/160)for dual-trunk type and 13.1%(21/160)for radial type.The main types of the middle hepatic vein included 61.9%(99/160)of segment 4(S4)hepatic vein converging to the left hepatic vein,36.9%(59/160)of S4 hepatic vein converging to the middle hepatic vein and 1.2%(2/160)of S4 hepatic vein independently converging to the inferior vena cava.The main types of the right hepatic vein consisted of 74.4%(119/160)of primary-trunk type S6 hepatic vein,22.5%(36/160)of dual-trunk type and 3.1%(5/160)of triple-trunk type.The proportion of umbilical fissure vein was 78.8%(126/160),of which 53.2%(67/126)converging to the root of left hepatic vein,23.8%(30/126)converging to the distal end of left hepatic vein,13.5%(17/126)converging to the root of middle hepatic vein,and 9.5%(12/126)converging to the space between middle and left hepatic veins.Anterior fissure vein

关 键 词：解剖变异 肝血管 前裂静脉 脐裂静脉 肝动脉变异Hiatt分型 成像 三维 肝切除术 

分 类 号：R657.3[医药卫生—外科学]