论文部分内容阅读
目的评价肝动脉、门静脉双期多层螺旋CT扫描及三维CT血管造影(3D CTA)在肝移植肝门血管重建术式选择中的应用价值。方法25例拟行肝移植的受者进行肝动脉及门静脉双期3D CTA,根据术前3D CTA所显示的肝门血管情况,初步计划术中肝门血管重建方案,最后与实际手术情况相比较。结果25例肝移植受者中15例为正常肝动脉解剖;10例有肝动脉解剖变异,占40%,其中以替代肝右、替代肝左、副肝左和副肝右动脉血管变异出现的情况居多。变异组中1例经DSA间接门静脉造影证实为门静脉海绵样变而放弃肝移植手术。其余24例接受肝移植手术的受者中,1例合并脾动脉瘤,术中行脾动脉结扎脾切除术;1例腹腔干起始部狭窄,3例经术前CT测量发现受者肝脏主要供养动脉直径<3mm,上述4例患者接受肝-主动脉间移植架桥血管重建供肝血供。1例有门静脉主干内血栓形成,术中门脉取血栓术后行标准门脉吻合。经DSA及手术证实,3D CTA对肝门区血管诊断符合率达100.0%;术前根据CTA预制定的手术方案和术中实施方案相比,符合率正常肝动脉解剖组可达93.3%(14/15例),肝动脉变异组可达77.8%(7/9例)。结论3D CTA能准确评价肝门区血管的变异和病变情况,对于术前准确合理地预制定肝门重建方案及术中准确快速地进行肝门血管吻合有着重要的意义。
Objective To evaluate the value of multislice spiral CT scan and three dimensional CT angiography (CTA) of hepatic artery and portal vein in hepatic portal graft reconstruction. Methods Twenty-five recipients undergoing liver transplantation underwent double-phase 3D CTA of the hepatic artery and portal vein. According to the preoperative 3D CTA, the portal vein was reconstructed. The final plan was compared with the actual operation . Results Of the 25 liver transplant recipients, 15 were normal hepatic artery dissection. 10 had hepatic artery anatomic variation, accounting for 40% of the total. Among them, hepatic artery replacement was replaced by left hepatic artery, Most cases. One patient in the variant group was confirmed by DSA indirect portal vein angiography as a portal vein sponge-like change to abandon the liver transplantation. Among the remaining 24 recipients undergoing liver transplantation, 1 patient had splenic aneurysm and had splenectomy underwent splenectomy. One patient had a stenosis at the beginning of celiac trunk and 3 patients underwent liver CT Arterial diameter <3mm, the above 4 patients underwent hepatic-aortic transvascular graft reconstruction of donor blood supply. One case had portal vein thrombosis. Intraoperative portal vein thrombectomy was performed with standard portal vein anastomosis. According to DSA and surgery, the coincidence rate of 3D CTA in the diagnosis of portal hypertension was 100.0%. Compared with the preoperative operation plan, preoperatively, CTA had 93.3% (14.3%) of patients with normal hepatic artery anatomy / 15 cases), hepatic artery variant group up to 77.8% (7/9 cases). Conclusion 3D CTA can accurately evaluate the variability and pathological changes of the hilar region, which is of great significance for preoperative accurate and reasonable preoperative hepatic portal reconstruction and accurate and rapid hepatic portal vein anastomosis during operation.