MSCT对成人活体右半肝移植静脉流出道重建方式的诊断价值

Value of Mutlti-slice Spiral CT in the Diagnosis of Hepatic Outflow Tract Reconstruction Manners in Adult Living Donor Liver Transplantation

目的探讨多层螺旋CT(MSCT)增强扫描及血管成像技术在诊断成人活体右半肝移植静脉流出道重建方式的价值。资料与方法2007年11月至2008年2月在本院接受不含肝中静脉的右半供肝活体肝移植手术患者16例。男10例,女6例,年龄36～63岁(平均49岁)。术中用冻存血管重建肝脏Ⅴ(V5)、Ⅷ(V8)段的肝中静脉粗大属支及右肝下静脉(IRHV)。重建模式及例数为:V5(n=1),V8(n=1),V5和V8(n=6),V5和IRHV(n=2),V5、V8和IRHV(n=6);16例受体重建血管29支。术后行MSCT三期增强扫描,并利用多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)技术行肝静脉血管成像。对移植肝静脉流出道进行动态观察,评价重建方式,随访11天～1个月。观察移植肝增强表现,记录受体术后2周及1个月血清总胆红素水平。结果成人活体右半肝移植重建肝中静脉属支的搭桥血管和右肝下静脉均得以显示,其中3支显影纤细,1支略窄,其余未见狭窄。移植肝淤血的肝段强化行为各异,术后1个月淤血程度减轻,受体血清胆红素水平降低。结论MSCT可以清晰显示重建肝中静脉属支的搭桥血管和右肝下静脉及血管走行和狭窄情况,有助于了解移植肝淤血程度,为临床治疗提供有用的信息。

Objective To discuss the value of multi-slice spiral CT（MSCT） enhanced scan and angiography in the diagnosis of hepatic outflow tract reconstructive manners in adult living donor liver transplantation （LDLT）. Materials and Methods From November 2007 to February 2008,16 recipients underwent the adult living donor liver transplantation with right lobe grafts without the middle hepatic vein. Large tributaries of middle hepatic vein and inferior right hepatic vein were reconstructed with cold-storage vein. Reconstructive types and numbers were listed as ： V5 （ n = 1 ） , V8 （ n = 1 ） , V5 and V8 （ n = 6 ） , V5 and IRHV （ n = 2 ） , V5, V8 and IRHV （ n = 6 ）. Twenty-nine veins were reconstructed in 16 cases. Three-phase enhanced CT scan were performed at the period of 11 days to 1 month after operation. The vein grafts were investigated by CT angiography （CTA） reconstructed with Multiplanar reconstruction （MPR） , maximum intensity projection （MIP） and volume rendering （VR） techniques. All the reconstructive manners were assessed retrospectively. All the hepatic outflow tracts were detected dynamically. The enhanced behavior of liver graft was detected. Two-time of Serum bilirubin level at 2 weeks and 1 month after operation were recorded. Results The inferior right hepatic vein （IRHV） and pass-by vessels which were used to reconstruct the tributaries of the middle hepatic vein could be displayed on CT images. The vessels showed unobstructed except 3 thin and 1 narrowed vessels The enhanced behavior of liver graft was varied. The degree of congestion and the serum bilirubin level decreased at 1 month after operation. Conclusion Multi-slice spiral CT can not only clearly display the pathway and stenosis of pass-by vessles and inferior right hepatic vein, hut also detect the congestion degree of liver graft, which will provide useful information to guide clinical therapy.