64层螺旋CT血管三维重建对胃周动脉的显示能力及其临床意义

Demonstration ability of 64-multislice spiral computed tomography with three-dimensional reconstruction for perigastric artery and its clinical significance

目的：探讨64层螺旋CT血管成像（64-MSCTA）三维重建技术对胃周动脉的显示能力。方法对2012年11月至2013年12月间南方医科大学南方医院收治的469例患者行腹部64-MSCTA，采用三维重建技术重建胃周动脉，观察胃周动脉的起源和走行。对肝动脉及其变异采用Michels分型，对胃右动脉采用Iino分型。结果469例患者中，5例因肝动脉显影异常未能显示肝脏动脉情况，其余464例完整显示腹腔干各级主要分支。显示经典肝动脉解剖者（Michels Ⅰ型）346例（74．6％）；显示肝动脉变异者118例（25．4％），其中9例（7．6％）变异不在Michels分型中。337例（72．6％）清晰显示了胃右动脉的起源及走行，其中近端型54例（16．0％），远端型221例（65．6％），尾端型56例（16．6％），其他6例（1．8％），包括3例自脾动脉发出以及3例自肠系膜上动脉发出。结论64-MSCTA三维重建技术可清晰显示胃周动脉及其血管解剖关系，有利于腹部精准手术的开展。

Objective To investigate the demonstration ability of 64-multislice spiral computed tomography angiography （MSCTA） with 3-D reconstruction image fusion for the anatomy of perigastric artery. Methods From November 2012 to December 2013 in the Nanfang Hospital, a total of 469 patients underwent abdominal 64-MSCTA. 3-D reconstruction technique computed tomography angiography （CTA） was used to reconstruct perigastric arteries. The origin and the course of perigastric arteries were observed. Branching pattern of the hepatic artery was classified by Michels standard , and branching pattern of the right gastric artery was classified into three types according to RGA ramification patterns. Results Five patients failed to demonstrate hepatic artery because of abnormal development. 3-D reconstruction clearly showed the perigastric arteries in other 464 patients （98.9%）. The most common branching pattern of hepatic artery was Michels type I in 346 patients （74.6%）. Hepatic artery variation was found in 118 patients （25.4%）, including 9 patients of non-Micles type （7.6%）. 3-D reconstruction clearly showed the branching pattern of the right gastric artery in 337 patients （72.6%）, including 54 （16.0%） of proximal pattern, 221 of distal pattern （65.6%）, 56 of caudal pattern （16.6%）, and 6 of other pattern（3 from splenic artery, 3 from superior mesenteric artery）. Conclusion 64-MSCTA with 3-D reconstruction can clearly reveal individual perigastric arteries , and can provide guidance for laparoscopic gastrectomy.