终末期肝泡型包虫病全离体自体肝移植术后的影像学评价

发布时间：2018-05-10 07:46

本文选题：HAE + 全离体自体肝移植手术　；参考：《青海大学》2017年硕士论文

【摘要】：目的:运用多层CT动态强化及MRI扫描并行后处理的方式比较观察肝泡型包虫终末期患者在进行全离体自体肝移植手术前后的影像学资料,着重对比观测手术前后的脉管体系,以此来比较手术前后情形,探究影像学评价在终末期的肝泡型包虫病在经过全离体自体肝移植手术前后的应用价值。材料与方法:收集2014年9月-2017年2月经临床确诊的15例经临床及影像诊断确诊的肝泡型包虫病患者。术前、术后均选用Phillips 256层CT及Philips1.5 T磁共振扫描仪进行CT多期动态增强、图像减薄、血管后处理及用MRI设备取MRCP序列扫描胆管并进行相关数据测量、收集,获取定量参数值:肝固有动脉管径、肝门静脉主干管径和胆总管管径。比较手术前及手术后这三组数值的差别并行统计学分析,手术前及手术后数值的比较方法用配对样本t检验。结果:1.肝泡型包虫病行完全离体自体肝移植手术前后,肝固有动脉显示清晰,术前、术后动脉直径相比,P0.05,表明术后肝固有动脉直径较前无明显统计学差异,离断血管吻合及恢复较好。2.手术前后,肝门静脉显示清晰,门静脉直径对比结果P0.05,术前术后门脉管径差异无统计学意义,术中离断的门脉恢复良好;3.术前术后MRCP检查结果,胆总管直径前后对比,P0.05,表明手术离断胆管吻合良好,胆管显示较术前无明显统计学差异。术后之后的患者均恢复较好,无明显复发或者转移现象。结论:影像学的方法对于完全离体自体肝移植手术医治终末期HAE,具备很好的评估意义,对于术前术后的病灶、术区及肝脏脉管体系均能良好地体现,对脉管系统能做出很好的评价,且对术后并发症可以很好地诊断并指导治疗;全离体自体肝移植作为一种新兴的治疗肝泡型包虫病的办法,手术前后离断脉管系统吻合经影像学检查测定后有较高的成功率,具有一定可行性。
[Abstract]:Objective: to compare and observe the imaging data of patients with hepatic alveolar hydatid before and after autologous liver transplantation with multi-slice CT dynamic enhancement and MRI scanning before and after operation, and to observe the vascular system before and after the operation. To compare the pre-and post-operative conditions and to explore the value of imaging evaluation in end-stage liver alveolar hydatidosis before and after the whole in vitro autologous liver transplantation. Materials and methods: 15 cases of hepatic alveolar hydatid disease diagnosed by clinical and imaging diagnosis from September 2014 to February 2017 were collected. Before and after operation, Phillips 256-slice CT and Philips1.5 T magnetic resonance scanner were used for multiphase dynamic enhancement, image thinning, blood vessel post-processing and MRCP sequence scanning of bile duct with MRI equipment. The quantitative parameters were obtained: the diameter of the proper hepatic artery, the diameter of the main hepatic portal vein and the diameter of the common bile duct. Statistical analysis was performed to compare the values before and after operation, and the comparison between pre-operation and post-operative values was performed by paired sample t-test. The result is 1: 1. Before and after complete autologous liver transplantation of hepatic alveolar hydatid disease, the proper hepatic artery was clearly displayed, and the diameter of the artery before and after operation was higher than that of P0.05, indicating that there was no significant difference in the diameter of the hepatic proper artery after operation, and the anastomosis and recovery of the transected artery were better. 2. Before and after operation, the hepatic portal vein was clear, the contrast result of portal vein diameter was P0.05. there was no significant difference in the diameter of portal vein before and after operation. The results of MRCP before and after operation showed that the diameter of common bile duct before and after operation was better than that before operation (P 0.05), and there was no significant difference in the display of bile duct between before and after operation. All patients recovered well after operation, without recurrence or metastasis. Conclusion: the imaging method is of great significance for the treatment of end-stage HAE after complete isolated autologous liver transplantation, and can be well demonstrated for the lesion, the area of operation and the hepatic vascular system before and after operation. The vascular system can be well evaluated, and the postoperative complications can be well diagnosed and treated. All in vitro autologous liver transplantation is a new method for the treatment of hepatic alveolar hydatid disease. The anastomosis of severed vascular system before and after operation has a high success rate and is feasible after imaging examination.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3;R445.2;R816.5

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