64层螺旋CT三维重建在肝脏门静脉右前支分段中的应用研究

The application of three-dimensional reconstruction of 64-slice CT in segmental anatomy of the right anterior portal vein

目的利用64层螺旋CT三维重建技术观察肝脏门静脉右前支分支类型及亚段的解剖标志,为肝段划分提供准确的影像学依据。方法共165例腹部CT增强扫描资料,重组门静脉血管树,分析门静脉右前支分段的解剖标志并对右前支3级血管进行分型。结果 145例(87.9%)右前支门静脉3级分支之间存在一缺少血管的裂隙,此裂隙将右前支分为腹侧段和背侧段,其中42例腹侧段及背侧段分支间分别存在一缺少血管的裂隙,并再分为两个亚段;在这一裂隙中有一肝中静脉或肝右静脉走行。20例(12.1%)右前支分为上段和下段。右前支依据门静脉3级分支的不同分为5种类型,Ia型25.5%(42/165例);Ib型43.6%(72/165例);Ic型18.8%(31/165例);IIa型7.9%(13/165例);IIb型4.2%(7/165例)。结论 64层螺旋CT三维重建技术可以清晰显示门静脉右前支的分支类型及亚段解剖标志,为肝脏右前叶亚段手术提供可靠的影像学依据。

Objective The purpose of this study was to observe the anatomical landmark of subsegment and ramifications of the third-order of right anterior portal branch by using three-dimensional reconstruction of 64-slice CT,so as to supply imaging anatomic data for the division of hepatic segments.Methods One hundred sixty five patients with abdominal CT enhanced scans were enrolled.The anatomical landmark and ramification types of the third-order of right anterior portal branch were demonstrated in terms of portal tree.Results There was a lacking vessels fissure among the third-order of portal branches of right anterior lobe in 145 patients.The portal branches of right anterior lobe were divided into ventral segment and dorsal segment by the lacking vessels oblique fissure.There were a lacking vessels fissure among branches of the ventral segment and dorsal segment respectively,and then were divided into two subsegment in 42 patients.A right hepatic vein or middle hepatic vein coursed in the intersegmental fissure.The right anterior lobe was divided into upper segment and lower segmen in 20 patients.The right anterior portals were divided into 5distinct anatomical types in according to the third-order of portal branches,type Ia 25.5%,type Ib 43.6%,type Ic 18.8%,type IIa 7.9%,type IIb 4.2%.Conclusion The three-dimensional reconstruction of 64-slice CT can clearly show the anatomical landmark of subsegment and branch pattern of the right anterior portal branch,which can provide reliable imaging reference for subsegmental discases in right anterior lobe.