肝移植患者手术前后CTA评估肝脏血供状态研究*

doi:10.3969/j.issn.1672-5069.2026.03.031

摘要/Abstract

摘要： 目的探讨CT血管成像(CTA)评价接受肝移植患者术前肝脏血供状态和术后肝动脉畅通的价值,为临床肝移植术前和术后评估提供依据。方法 2020年12月～2023年5月在我院接受肝移植患者129例,采用CTA和超声检查评估肝动脉、下腔静脉和肝静脉结构和术后肝脏静脉系统通畅情况。结果在129例患者中,CTA显示肝动脉Michels I型99例(76.7%),II型 8例,III型 7例,IV型 5例,V型 3例,VI型 3例和其他型 4例,术前CTA显示的肝动脉分型评估与术中所见均一致; CTA显示中、右肝静脉合干的灵敏度、显示中、左肝静脉合干的灵敏度、左、中、右肝静脉合干的灵敏度、显示左、中、右肝静脉合干的准确度、显示未合干的灵敏度分别为86.2%、94.7%、100.0%、80.6%和89.1%,均显著高于超声检查的58.6%、65.8%、60.0%、52.4%和62.2%(P<0.05);术后,CTA诊断门静脉血栓的灵敏度、诊断门静脉瘤栓的灵敏度、诊断门静脉瘤栓的准确度、诊断肝静脉闭塞的准确度、诊断下腔静脉狭窄的灵敏度和诊断下腔静脉狭窄的准确度分别为89.5%、80.0%、71.4%、96.7%、88.9%和87.5%,均显著高于超声检查的52.6%、50.0%、50.4%、65.6%、44.4%和57.5%(P<0.05)。结论 CTA检查肝脏血管系统结构和术后通畅性的准确率均较高,对指导肝移植手术前后血管监测具有重要的临床应用价值。

关键词: 肝移植, CT血管成像, 肝动脉, 下腔静脉, 肝静脉, 门静脉, 诊断

Abstract: Objective The purpose of this study was to investigate pre- and post-operative evaluation of hepatic blood supply by CT angiography (CTA) in patients undergoing liver transplantation(LT). Methods A total of 129 patients with various liver diseases were encountered in our hospital between December 2020 and May 2023, and all underwent LT. Pre- and post-operationally, CTA and ultrasonography (US) were conducted to evaluate the general structure of the hepatic artery and vein, including inferior vena cava, portal vein and hepatic vein. Results Of the 129 patients receiving LT, CTA showed Michels type I hepatic artery in 99 cases (76.7%), type II in 8 cases, type III in 7 cases, type IV in 5 cases, type V in 3 cases, type VI in 3 cases and others in 4 cases, all proven by surgery; the sensitivity by CTA for combined trunk of middle and right hepatic veins, for combined trunk of middle and left hepatic veins, for combined trunk of left, middle and right hepatic veins, the accuracy for left, middle and right hepatic veins and sensitivity for no combined vein were 86.2%, 94.7%, 100.0%, 80.6% and 89.1%, all much superior to 58.6%, 65.8%, 60.0%, 52.4% and 62.2%(P<0.05) by US; post-operationally, the sensitivity for portal vein thrombosis, for portal vein tumorous thrombus, the accuracy for portal vein tumorous thrombus, for hepatic vein occlusion, the sensitivity and accuracy forinferior vena cava stenosis by CTA were 89.5%, 80.0%, 71.4%, 96.7%, 88.9% and 87.5%, all much superior to 52.6%, 50.0%, 50.4%, 65.6%, 44.4% and 57.5%(P<0.05) by US. Conclusion The CTA has a accuracy in examining the patency of liver vasculature, which might guide surgery strategy and post-operational surveillance.

Key words: Liver transplantation, CT angiography, Hepatic artery, Inferior vena cava, Portal vein, Hepatic vein, Diagnosis

郝成, 彭勇, 杜霞. 肝移植患者手术前后CTA评估肝脏血供状态研究^*[J]. 实用肝脏病杂志, 2026, 29(3): 442-445.

Hao Cheng, Peng Yong, Du Xia. Pre- and post-operative evaluation of hepatic blood supply by CT angiography in patients undergoing liver transplantation[J]. Journal of Practical Hepatology, 2026, 29(3): 442-445.

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肝移植患者手术前后CTA评估肝脏血供状态研究^*

Pre- and post-operative evaluation of hepatic blood supply by CT angiography in patients undergoing liver transplantation

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