64层容积CT在直接性肝内门腔分流术穿刺定位中的应用

Application of 64-slice volume CT in the puncture localization in direct intrahepatic portacaval shunt

目的通过64层容积CT(64-VCT)对门静脉左、右支与肝后下腔静脉模拟穿刺途径的角度进行测量,以期为临床直接性肝内门腔分流术(DIPS)提供解剖学资料。方法将接受64-VCT检查的60例患者分为非肝病组(n=43,非肝病患者)与肝硬化组(n=17,肝硬化患者)。采用64-VCT扫描仪(GE,美国)、双筒CT专用高压注射器(Nemoto,日本)进行操作,并将所得数据在GE ADW4.2工作站进行处理。结果非肝病组及肝硬化组,门静脉左、右支1、2 cm处与肝后下腔静脉的模拟穿刺途径,下等分线入口顺行角度均大于上等分线相应途径角度(P<0.05);门静脉左、右支1 cm处与肝后下腔静脉上、下等分线的模拟穿刺途径出口角度大于门静脉左、右支2 cm处相应途径角度(P<0.05)。结论 64-VCT可提供活体解剖学资料,有助于DIPS的穿刺定位。

Objective To measure the angle of analog puncture approach between left and right branch of portal vein and retrohepatic segment of inferior vane cava by means of 64-slice volume CT（64-VCT）,and provide anatomical data for clinical direct intrahepatic portacaval shunt（DIPS）.Methods 60 patients accepted 64-VCT examination were divided into non liver cirrhosis group（n=43,patients with non-liver cirrhosis） and liver cirrhosis group（n=17,patients with liver cirrhosis）.64-VCT scanner（GE,USA） and CT-specific binocular high-pressure injector（Nemoto,Japan） were employed,and all data obtained were processed in the GE ADW4.2 workstation.Results In non-liver cirrhosis and liver cirrhosis groups,antegrade angles of analog puncture approach between 1 or 2 cm of left and right branch of portal vein and lower bisector of retrohepatic segment of inferior vane cava were greater than those of corresponding approach of upper bisector（P〈0.05）.Exit angles of analog puncture approach between 1 cm of left and right branch of portal vein and upper or lower bisector of retrohepatic segment of inferior vane cava were greater than those of corresponding approach of 2 cm of left and right branch of portal vein（P〈0.05）.Conclusion 64-VCT can provide anatomical data in vivo and contributes to puncture localization in DIPS.