【摘要】 目的:探讨64层螺旋CT腹腔干、门静脉及下腔静脉成像技术对肝脏移植受体血管结构评价的临床价值方法:对30例拟行肝脏移植手术的患者行增强后动脉期、门静脉期及下腔静脉期扫描。对每一例病例均行腹腔干、门静脉及下腔静脉三维重建及二维重组并与轴位图像结合分析患者血管情况。根据受体肝脏血管情况筛选出其中24例适宜手术的患者,初步拟定手术方案行肝移植手术,并在手术后与肝移植手术医师的术中探查结果相比较,探讨术前CT血管重建的准确性。结果:腹腔干成像可发现3例腹腔干狭窄,1例腹腔干动脉瘤,2例脾动脉瘤,2例肝脏主要供血动脉直径<3mm,10例肝动脉走行变异。门静脉成像发现2例肝门静脉海绵样变;12例肝门静脉栓塞,其中5例肝内门静脉栓塞,5例肝外门静脉主干栓塞(其中3例合并肠系膜上静脉栓塞);2例肝内门静脉及肝外门静脉主干均有栓塞。2例肝门静脉海绵样变及3例肝外门静脉主干及肠系膜上静脉广泛栓塞的患者因不适宜手术而未能行肝移植手术。下腔静脉成像发现2例下腔静脉癌栓,其中1例栓子接近右心房入口处,不适宜手术未能行肝移植手术;2例下腔静脉肝后段狭窄。30例中24例均成功行肝移植手术,术中所见与CT血管成像所见完全相符合。结论:64层螺旋CT血管成像适合用来全面准确评价拟行肝脏移植的受体的血管状态,对筛选适宜手术的病例并协助手术方案的制定有重要价值。更多还原

【Abstract】 Objective:To explore the clinical value of 64-slice spiral CT angiography(celiac artery,portal vein,inferior vena cava) in evaluating the hepatic vessels of liver recipients.Methods:Thirty patients who would undergone the operation of liver transplantation underwent three-phasic CT enhanced scan with 64-slice SCT.Two-dimensional and three-dimensional reformation were performed in all cases by means of MPR(coronal,sgittal,oblique),MIP,SSD,VR and clipped VR.We used reformation imaging with axial imaging to analyze the hepatic vessels of liver recipients.Results:CT angiography of celiac artery showed 3 cases with celiac artery stenosis,1 case with celiac artery aneurysm,2 cases with splenic artery aneurysm,2 cases with the diameter of main hepatic supply artery no more than 3mm,10 cases with hepatic artery variant.CT portography showed 2 cases with portal vein sponge degeneration,12 cases with portal vein thrombosis.3 cases with wide thrombosis in portal vein and superior mesenteric vein and 2 cases with portal vein sponge degeneration gave up the operation.CT venography found 2 cases with embolism in inferior vena cava and 2 cases with stenosis in inferior vena cava,1 case with embolism near the right atrium also gave up operation.The other 24 cases received hepatic transplantation successfully,all hepatic vascular findings in 64 slice CT angiography conformed the findings in the operation.Conclusion:64 slice CT angiography could overall evaluating the hepatic vessels of liver recipients and was suitable to choice the cases that could be receipt liver transplantation and was also very useful for drawing up the operation plan.更多还原