128层MDCTA对肝动脉解剖变异的评价

发布时间：2018-11-28 07:54

【摘要】：目的 应用MDCTA及其图像后处理技术对肝动脉解剖变异的发生率进行评价（细致到肝段），为肝移植、肝癌外科手术及介入治疗提供有价值的信息。 材料与方法 收集2012年4月-2012年12月在泰安市中心医院应用128层MDCT行强化扫描的病人共691例（男472人；女219人；平均年龄59岁），对其进行回顾性分析。图像质量根据顺序量表进行分级。所有病例的薄层图像均使用最大密度投影（MIP）、容积再现（VR）后处理技术进行图像分析及后处理。根据Michels分型将肝动脉解剖进行分类，并与国内外四组数据进行比较。将肝脏II、III、IV段及肝右叶的肝动脉依据肝段动脉的起源与走形不同进行详细分类，并统计其发生率，分析各种类型的特点及规律，进一步阐明熟悉肝动脉解剖变异在肝癌手术及介入治疗中的意义。 结果 691例患者中，103例（14.91%）由于图像质量欠佳被排除。剩余的588例患者中（男性396人，女性192人；年龄范围，22-94岁；平均年龄，59岁），检测出肝动脉解剖变异数137例（23.30%），与经典的Michels研究数据比较，有统计学意义（P＜0.05）。 与国内外4组同类数据进行各种分型的比较，并通过总结国内外文献提出的对肝动脉变异的各种分型，提出新的分型，对肝动脉分型进行完善和补充。 将肝癌组中行介入治疗的患者的CTA资料与DSA资料进行对比，结果无统计学差异（χ2=0.003， P值=0.960＞0.05）。 根据对588例数据中肝II、III段动脉的观察将肝II、III段动脉依据其是否来源于正常的肝左动脉分为两大类，即第一类Normal LHA和第二类Variant LHA，分别称为S2-Normal LHA型、 S2-Aberrant LHA型/S3-NormalLHA型、S3-Aberrant LHA型，其发生率分别为82.65%（486），17.35%（102），82.65%（486），17.35%（102）。其中S2/S3-Normal LHA型又被分为7个亚型，S2/S3-Aberrant LHA型分为6个亚型。肝Ⅳ段动脉（A4）依据其供血动脉的起源及数目分为五型，即LHA型、RHA型、PHA型、Dual型和Tri型，，各型发生率分别为56.12%（330）、28.57%（168）、2.21%（13）、12.76%（75）、0.34%（2）。肝右叶供血动脉依据其血管走形分为7种类型（用阿拉伯数字表示，分别为1、2、3、4、5、6、7、8型），其发生率分别为43.54%（256）、15.14%（89）、15.31%（90）、1.7%（10）、2.89%（17）、6.29%（37）、13.95%（82）、1.19%（7）。 结论： 结果表明，128层MDCTA在分析肝动脉解剖方面有重要意义，可以获得与DSA类似的显影效果。肝动脉解剖变异在受检人群中具有相当高的发生率(23.30%)，其变异类型复杂多样，但有一定的规律性。
[Abstract]:Objective to evaluate the incidence of anatomical variation of hepatic artery (from liver segment to liver segment) by using MDCTA and its image post-processing techniques, and to provide valuable information for liver transplantation, liver cancer surgery and interventional therapy. Materials and methods A total of 691 patients (472 males; 219 females; mean age 59 years) underwent 128-layer MDCT intensive scanning in Taian Central Hospital from April 2012 to December 2012 were retrospectively analyzed. Image quality was graded according to sequential scale. The thin-layer images of all cases were analyzed and postprocessed by maximum density projection (MIP), volume reconstruction (VR) postprocessing technique. Hepatic artery anatomy was classified according to Michels classification and compared with four groups of data at home and abroad. The hepatic arteries of II,III,IV segment and right lobe of liver were classified in detail according to the origin and shape of hepatic segmental artery, the incidence rate was counted, and the characteristics and rules of various types were analyzed. To further elucidate the significance of familiar anatomical variation of hepatic artery in liver cancer surgery and interventional therapy. Results of the 691 patients, 103 (14.91%) were excluded because of poor image quality. The remaining 588 patients (male 396, female 192; age range, 22-94 years; The mean age, 59 years old), 137 cases (23.30%) of hepatic artery anatomical variation were detected, compared with the classical Michels data, there was statistical significance (P < 0. 05). Compared with four groups of similar data at home and abroad, and through summing up the domestic and foreign literature on the various types of hepatic artery variation, put forward a new classification, to improve and supplement the classification of hepatic artery. There was no significant difference between CTA and DSA in patients with liver cancer treated by interventional therapy (蠂 2 0.003, P = 0.960 > 0. 05). According to the observation of hepatic II,III segmental arteries in 588 cases, the hepatic II,III segmental arteries were divided into two categories according to whether they originated from normal left hepatic arteries. The first type of Normal LHA and the second type of Variant LHA, were called S2-Normal LHA type, respectively. The incidence of S2-Aberrant LHA / S3-NormalLHA and S3-Aberrant LHA were 82.65%, 17.35%, 82.65% and 17.35%, respectively. Among them, S2/S3-Normal LHA type is divided into 7 subtypes and S2/S3-Aberrant LHA type is divided into 6 subtypes. Hepatic 鈪

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