应用CTA技术和超声评估肝移植术患者术前肝脏血供状态研究*

doi:10.3969/j.issn.1672-5069.2022.04.032

摘要/Abstract

摘要： 目的研究计算机断层扫描血管成像(CTA)和超声检测评估肝移植术患者术前肝脏血管解剖变异和管腔通畅性。方法 2014年5月～2020年5月我院收治的接受肝移植手术患者138例,术前均行腹部三期CT增强扫描、CTA后处理[包括容积再现(VR)和最大密度投影(MIP)等重建和超声检查。分析肝动脉、门静脉、肝静脉和下腔静脉及其侧支循环情况。结果 138例患者中,CTA显示107例(77.5%)肝动脉解剖起源和走行正常(Michels aⅠ型),31例(22.5%)存在肝动脉解剖变异,肝动脉管腔未出现狭窄和异常扩张情况,1例(0.7%)合并脾动脉瘤;136例患者术中肝动脉解剖与术前CTA评估一致;CTA诊断血栓和瘤栓的灵敏度和准确度分别为83.3%和68.6%,而超声检查诊断为58.3%(P<0.05)和60.0%;超声和CTA诊断肝静脉和下腔静脉通畅性的准确率均为99.3%。结论相对于超声检查,CTA检查可准确评估肝移植术前肝动脉解剖变异情况,对门静脉栓子定性诊断的准确性也较高,且可清晰显示门静脉侧支循环开放情况。

关键词: 肝移植, 血管解剖变异, 计算机断层扫描血管成像, 超声, 诊断

Abstract: Objective The aim of this study was to investigate the computed tomography angiography (CTA) and ultrasonography in evaluation of vascular anatomic variation and lumen patency in patients undergoing liver transplantation(LT). Methods 138 patients receiving LT were admitted to our hospital between May 2014 and May 2020, and before operation, all patients underwent three-stage CT enhancement scan, CTA post-processing vascular reconstruction and ultrasonography. The hepatic artery, portal vein, hepatic vein and inferior vena cava, as well as collateral circulation were observed. Results Among 138 patients, CTA showed that 107 (77.5%) had hepatic artery of Michels type I and 31 (22.5%) had hepatic artery anatomic variation; there was no stenosis or abnormal dilatation of the hepatic artery lumen, and only one case (0.7%) had splenic aneurysm; the intraoperative observation of hepatic artery was consistent with preoperative CTA assessment in 136 patients; the sensitivity and accuracy by CTA in the diagnosis of portal thrombus and tumor thrombus were 83.3% and 68.6%, while those by ultrasonography were 58.3% (P<0.05)and 60.0%; both the accuracy by ultrasonography and CTA in diagnosing the patency of hepatic vein and inferior vena cava was 99.3%. Conclusion As compared with ultrasonography, the CTA could accurately evaluate the anatomic variation of hepatic artery and portal vein thrombosis, and could clearly show the opening of collateral circulation of portal vein before LT.

Key words: Liver transplantation, Vascular anatomic variation, Computed tomography angiography, Ultrasonography, Diagnosis

宗金娟, 周明, 史家乐. 应用CTA技术和超声评估肝移植术患者术前肝脏血供状态研究^*[J]. 实用肝脏病杂志, 2022, 25(4): 583-586.

Zong Jinjuan, Zhou Ming, Shi Jiale. Application of computed tomography angiography and ultrasonography in preoperative assessment of hepatic blood vessels in patients undergoing liver transplantation[J]. Journal of Practical Hepatology, 2022, 25(4): 583-586.

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应用CTA技术和超声评估肝移植术患者术前肝脏血供状态研究^*

Application of computed tomography angiography and ultrasonography in preoperative assessment of hepatic blood vessels in patients undergoing liver transplantation

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