多层螺旋CT术前评价右叶活体肝移植供肝血管系统

Preoperative multiple-slice CT evaluation on liver vessels of right hepatic lobe living donor liver transplantation

目的探讨MSCT在右叶活体肝移植(LDLT)术前供体筛选中的应用价值。方法对40名拟行肝右叶捐献的志愿者于LDLT术前行MSCT腹部平扫及三期增强扫描,由2名医师观察肝脏血管系统的显影情况(采用4分法进行评价)、解剖结构及变异,并对最终作为供体接受肝右叶切除术者的CT表现及术中所见进行对照分析。结果 2名医师对肝动脉(HA)、门静脉(PV)、肝静脉(HV)分支及副肝静脉(AHV)显影情况的评分均为3～4分,观察者间一致性好(Kappa值分别为0.84、1.00、1.00和1.00)。40名志愿者中,HA正常19名,变异21名;PV正常28名,变异12名。10名志愿者因HA变异影响肝右叶捐献而被排除,包括7名肝右动脉(RHA)纤细和3名S4段肝动脉(S4A)变异;7名志愿者因PV变异被排除,包括2名PV右前支起自门静脉左支(LPV)、3名三叉型PV和2名门静脉右支(RPV)短干。最终包括2名RPV短干、1名PV右后支起自PV主干及2名三叉型PV在内的共15名志愿者作为供体接受肝右叶切除术。LDLT术中所见15名供体的肝脏血管系统解剖结构均与术前MSCT检查结果相符。结论MSCT是LDLT术前评价供肝血管系统的有效方法。

Objective To explore the application value of MSCT in evaluating the anatomy of liver vascular tree in poten tial donors before right lobe living donor liver transplantation （LDLT）. Methods Abdominal MSCT examinations, including plain and tri-phase contrast-enhanced scans were performed on 40 potential donors of LDLT preoperatively. The display situation （using 4-point scale）, anatomy and variation of hepatic vascular system were analyzed by 2 radiologists. Moreover, a contrast analysis between MSCT and operation results of the donors who finally underwent right hepatic lobectomy was done. Results All the scores of display situation in hepatic artery （HA）, portal vein （PV）, hepatic vein （HV） and accessory hepatic vein （AHV） were 3-4 by 2 radiologists with good consistency between them （Kappa value was 0.84, 1.00, 1.00 and 1.00, respectively）. Among all 40 potential donors, normal vessel structure of HA and PV was found in 19 and 28, while variation of HA and PV was found in 21 and 12, respectively. Totally 10 potential donors with HA variation （including 7 of slender RHA and 3 of segment 4 artery variation） and 7 potential donors with PV variation （including 2 of PV right anterior branch stemming from left PV, 3 of trifurcation of main PV and 2 of short right PV） were ruled out, because of the influence to liver donation. Right hepatic lobectomy was finally performed on 15 donors, though 5 donors were found with vascular variation, including 2 of short right PV, 1 of PV right posterior branch stemming from main PV and 2 of trifurcation of main PV. MSCT findings of hepatic vascular system in the 15 donors were consistent with operation results. Conclusion MSCT is effective in presenting hepatic vascular of potential donor before right lobe LDLT.