螺旋CT三维重建对各肝段引流静脉的研究及其临床意义

Research and clinical signification on conducting vein of hepatic segments by 3-dimentional reconstruction of helical CT

目的 :明确生理状态下的肝静脉在各个肝段内的解剖分布 ,以提高肝移植或肝段切除术后残肝功能的恢复。方法 :10 0例采用经动脉性肝门静脉CT造影 ,重建肝门静脉以及肝静脉三维结构。设定以肝右、肝中、肝左静脉为主肝静脉 ,以肝段之间走行或某一肝段周边存在的粗大肝静脉为副肝静脉 ,观察各肝段引流静脉的形式。结果 :在肝脏第 2～ 8肝段内 ,发现有 7种不同的副肝静脉 ,其出现率第 8段肝静脉为 67%,第 7段肝静脉为 91%,第 6、7段肝静脉为 73 %,第 5、8段肝静脉为 5 2 %,第 4段肝静脉为5 8%,第 3、4段肝静脉为 3 9%,第 2段肝静脉为 5 6%。各段内肝静脉的引流方式表现为三种形式。结论 :采用经动脉性肝门静脉CT造影 ,重建肝静脉及肝门静脉来观察肝段引流静脉 ,这对决定术式及判断预后方面将起很大的作用。

Objective:To reconstruct portal vein and 3-dimentional structures of hepatic vein by means of CT portal vein radiography from artery,and observe the branch type of hepatic vein. Methods:100 patients were selected as the object of the observation.The catheter was put into superior mesenteric artery,contrast medium was injected,and then liver was continuously scaned during portal vein segment and hepatic vein segment.Regional growing method was used as 3-D reconstruction of portal vein and hepatic vein.Right,middle and left hepatic vein were set as main hepatic veins and the hepatic veins passing between hepatic segments or in a hepatic segment were set as accessory hepatic vein.The branch type of hepatic vein in every hepatic segment was observed and analyzed.Results:Main hepatic veins and accessory hepatic veins were distributed surround the portal vein of the segment.3 drainage patterns of hepatic veins in the hepatic sub-segment were observed.The occurrence of accessory hepatic vein in the hepatic segment was 67% for S8HV,91% for S7HV,73% for S6、7HV,52% for S5、8HV,58% for S4HV,39% for S3、4HV and 56% for S2HV.Conclusion:Branch type of hepatic vein in the hepatic segment is defined,which is important for determining operation methods and judging prognosis.