肝动脉解剖变异影像学研究

The imaging study of hepatic arterial variations

目的用数字减影血管造影(DSA)和CT血管造影(CTA)进一步探讨肝动脉解剖变异的种类、发生率及特点。方法回顾分析1000例因肝脏疾病而行DSA检查患者的临床资料、肝动脉的DSA,以及其中的32例肝动脉解剖变异的CTA表现。观察肝动脉的起源、走行、分布情况,并分别统计其变异类型和发生率。结果1000例肝动脉造影中,正常型727例,占72.7%;肝动脉变异273例,占27.3%。273例肝动脉变异中属于Michels分型的148例,占14.8%。Michels分型未包括在内者为125例,占12.5%。其中肝总动脉分叉变异54例,占5.4%,肝动脉起源变异214例,占21.4%,肝总动脉分叉+肝动脉起源变异5例,占0.5%。以上变异合并多种变异共存21例,占2.1%。结论肝动脉解剖变异的种类具有多样性、复杂性。除DSA外,CTA亦可显示肝动脉解剖变异。肝胆外科和影像科医师了解肝动脉解剖变异对于术前制定手术方案、提高诊断准确性等有重要意义。

Objective To evaluate and describe the prevalence of hepatic arterial variants seen at digital subtraction angiography （DSA） and computed tomography angiography （CTA）. Methods A total of 1000 selective celiac and superior mesenteric, visceral angiographies or computed tomography angiography performed on patients with hepatic diseases were analyzed retrospectively. The origins ,courses and branches of hepatic arteries were observed. We evaluated the types and frequency of anatomical variations of the hepatic arteries. Results The standard hepatic arterial anatomy was seen in 72.7% and the arterial anatomy was anomalous in 273 out of 1000 cases with an overall incidence of hepatic artery anomalies of 27.3%. One hundred and forty-eight（14. 8%） of the cases fitted Michels＇ classification. But 125 patients （12.5%） present a lot of types of anatomic arterial variations of the hepatic arteries which were not reported in Michels＇ classification. They were variations of common hepatic arterial furcation in 5.4%, original variations of the hepatic arteries in 21.4%, combination of furcation and original variations of the hepatic arteries in 0.5 % and coexistence of multiple anomalies in the celiac-mesenteric arterial system in 2.1%. Conclusion The anatomic variation of the hepatic arteries is characterized by a striking degree of polymorphism and complexity. Besides DSA, CTA has also value in finding hepatic arterial variations. Since the pattern of different types of arterial anatomy can require specialized preoperative diagnostic as well as intraoperative strategies, knowledge of these abnormalities is of major importance for the surgeons as well as the radiologists.