左肺上叶静脉解剖分型MSCT评价及临床应用

MSCT evaluation and clinical application of anatomical classification of left superior pulmonary vein

目的应用多层螺旋CT(MSCT)对健康人左肺上叶肺静脉解剖及引流模式分型,为解剖性肺段切除术提供帮助。方法收集200例肺无异常胸部CT影像资料,通过容积重建(volume reconstruction,VR)获得静脉解剖及引流模式图,统计各静脉分型出现率;重建5 mm轴位最大密度投影(maximum density projection,MIP)图,辨识对应各分型。结果左肺上叶静脉根据共干情况不同可分为:V_(1+2)型,V_(2+3)型,及V_(1+2a)V_(2+3bc)型,其出现率分别为69%(138/200)、17.5%(35/200)、13.5%(27/200)。其特点为:V_(1+2)为V_(1)与V_(2)共干,其各自发出属支相互无联系;V_(2+3)型中V_(2)与V_(3)共干,V_(1)与V_(2+3)分别汇入左上肺静脉干;V_(1+2a)V_(2+3bc)型,此型主要是V_(2)变异较大。左肺上叶舌段静脉V_(4)、V_(5)共干时,其属支各自无联系,V_(4)存在与V_(3b)共干的情况,并各自具有不同的引流特点。结论左肺上叶因舌段的存在,其静脉分型更为复杂,MSCT所得静脉解剖及引流模式图结合5 mm轴位MIP图可清楚显示肺静脉解剖分型,作为其解剖识别常规手段。

Objective To study the anatomic and drainage patterns of pulmonary veins in the superior lobe of left lung in healthy people with Muti-slice spiral CT(MSCT),which providing reference for anatomical segmental resection of lung.Methods Two hundred cases of normal chest CT plain scan data were collected,and the venous anatomy and drainage pattern map were obtained by volume reconstruction(VR),and the occurrence rate of each vein type was observed and counted.Combined with the reconstruction of 5 mm axial MIP map,the corresponding types were identified.Results The left superior pulmonary vein can be divided into:(1)V_(1+2)type,(2)V_(2+3)type,(3)V_(1+2a)V_(2+3bc)according to the condition of common trunk,and the occurrence rates were 69%(138/200),17.5%(35/200)and 13.5%(27/200)respectively.Its characteristics were as follows:when V_(1+2)dries together,the branches then sent out were not related to each other;in V_(2+3)type,V_(2)and V_(3)dries together,and V_(1)and V_(2+3)respectively flowed into the left superior pulmonary vein stem;in V_(1+2a)V_(2+3bc)type,V_(2)mainly had a large variation;when V_(4)and V_(5)of the left upper lobe lingual segment vein dries together,their branches were not related to each other,and V_(4)had the same situation with V_(3b),and each had their different drainage characteristics.Conclusions The vein classification of the superior lobe of left lung is more complicated due to the presence of lingual segment.Venous anatomy and drainage pattern obtained by MSCT combined with 5 mm axial MIP can clearly show the pulmonary vein anatomical classification,which can be used as a routine method for its anatomical identification.