【作者】 卢川；

【导师】 刘作勤；

【作者基本信息】 山东大学 ， 影像医学与核医学， 2005， 硕士

【摘要】 目的:进一步探讨肝动脉解剖变异的种类、发生率及临床意义,并结合文献提出肝动脉变异的新分型。 方法:回顾分析1000例因肝脏疾病而行DSA检查患者的临床资料及肝动脉DSA表现。观察肝总动脉、肝固有动脉、肝右动脉、肝中动脉、肝左动脉的起源走行、分布情况,并分别统计其变异类型和发生率。 结果:1000例肝动脉造影中,正常型727例,占72.7%。肝动脉变异273例,占27.3%。 273例肝动脉变异中属于Michels分型的148例,占14.8%。其中Michels Ⅱ型33例,占3.3%;Michels Ⅲ型53例,占5.3%:Michels Ⅳ型11例,占1.1%;Michels Ⅴ型12例,占1.2%:Michels Ⅵ型17例,占1.7%:Michels Ⅷ型1例,占0.1%:Michels Ⅸ型21例,占2.1%。未见Michels Ⅶ型和Michels Ⅹ型。 273例肝动脉变异中Michels分型未包括在内者为125例,占12.5%。其中肝总动脉分叉变异54例,占5.4%:肝动脉起源变异66例,占6.6%:肝总动脉分叉变异+肝动脉起源变异5例,占0.5%。以上肝动脉变异同时合并腹腔干—肠系膜系统等动脉的多种变异共存21例,占2.1%。肝总动脉分又变异包括:无肝固有动脉,肝总动脉分肝左动脉、肝右动脉、胃十二指肠动脉(三分叉)43例,占4.3%:无肝固有动脉,肝总动脉分肝左动脉、肝右动脉、胃十二指肠动脉、胃右动脉或迷走十二指肠动脉(四分叉)10例,占1.0%;无肝固有动脉,肝总动脉分肝左中右动脉、胃十二指肠动脉、胃右动脉(五分叉)1例,占0.1%。肝动脉起源变异中:替代肝左动脉变异起源于腹腔干1例(占0.1%)、肝总动脉11例(占1.1%)、胃十二指肠动脉1例(占0.1%)。替代肝右动脉变异起更多还原

【Abstract】 Objective: The purpose of this study is to investigated the types and frequency of the individual anatomical variations of the hepatic arteries and its importances , to classify anatomic variations of the hepatic arteries and put forward to a new classification of hepatic arterial variations. Material and method: A total of 1000 selective celiac and superior mesenteric or visceral angiographies performed on patients with hepatic diseases were analyzed retrospectively. The origins and branches of the common hepatic artery , proper hepatic artery, left hepatic artery .middle hepatic artery ,and right hepatic artery were observed. We evaluated the types and frequency of anatomical variations of the hepatic arteries . Results: The standard hepatic arterial anatomy was seen in 72.7% and the arterial anatomy was anomalous in 273 out of 1000 cases with an overall incidence of hepatic artery anomalies of 27.3%.148(14.8%) of the cases fitted Michels’ classification. Michels Ⅱ was seen in 3.3%. Michels Ⅲ in 5.3%, Michels Ⅳ in 1.1% , Michels Ⅴ in 1.2%, Michels Ⅵ in 1.7%, Michels Ⅷ in 0.1% and finally Michels Ⅸ in 2.1%. There were no Michels Ⅶ or Ⅹ variants.However, 125 patients (12.5%) present a lot of types of anatomic arterial variations of the hepatic artery which are not reported in Michels’ classification . They are variations of common hepatic arterial furcation in 5.4%, original variations of hepatic arteries in 6.6% .combination of variations of common hepatic arterial furcation with original variations of hepatic arteries in 0.5% and coexistence of multiple anomalies in the celiac-mesenteric arterial system in 2.1%.Variations of common hepatic arterial furcation included the trifurcation of the common hepatic artery to the gastroduodenal and to the right and left hepatic arteries in 4.3%, quardrifurcation of the common hepatic artery to the gastroduodenal and to the right and left hepatic ■arteries and right gastric arteries in 1.0% and the common hepatic artery to the gastroduodenal and to the right .middle and left hepatic arteries and right gastric artery in 0.1%.Regarding the original variations of hepatic arteries, replaced left hepatic arteries arose from the celiac trunk in1.0%, the common hepatic in 1.1%, gastroduodenal artery in 0.1%. Replaced right hepatic arteries arose from the celiac axis in 0.6%, the common hepatic artery in 0.2%, gastroduodenal in 1.1% and splenic artery 0.1%. Replaced middle hepatic arteries arose from the common hepatic artery in 0.1%, gastroduodenal in 0.3% and right renal artery in 0.1%.Accessory right hepatic arteries originated from the celiac axis in 0.1%, the common hepatic artery in 0.3%and gastroduodenal artery in 1.2%.Proper hepatic artery originated from the superior mesenteric artery in 0.1%.Duplicated hepatic arteries originated separately in the celiac trunk in 0.2%. In 0.9% of the cases there was combinations of anomalies of both replaced or accessory right hepatic arteries with replaced or accessory left hepatic arteries .which were not classified by Michels. The combination of the replaced or accessory right hepatic arteries with replaced or accessory left hepatic arteries showed the complex variations of the hepatic arteries. Coclusions: In our series the percentage of hepatic artery variations is in agreement with those reported in the literatures. But the anatomic variations of the hepatic arteries are characterized by a striking degree of polymorphism and complexity . When there is one hepatic arterial variation, there is a high chance of being multiple variations. In combination those reported in the literatures with our study , we put forward to a newer classification of hepatic arterial anatomy which is standard hepatic artery , variation of common hepatic arterial furcation , original variation of hepatic arteries .combination of furcation with original variations of hepatic arteries and coexistence of multiple anomalies in the celiac-mesenteric arterial system. To avoid potentially disastrous complications and increase the rates of success of operations , the recognition of anatomic vascular abnormalities of the hepatic arteries is fundamental to liver transplantation surgeons, generalsurgeons .pretreatment planning for patients requiring hepatic arterial infusion chemotherapy .hepatic arterial infusion pump placement . Realization of this vascular pattern should make identification of the CTA , MRA of hepatic arteries easier for radiologists .更多还原