發(fā)布時間：2018-11-28 07:54

【摘要】：目的 應用MDCTA及其圖像后處理技術對肝動脈解剖變異的發(fā)生率進行評價（細致到肝段），為肝移植、肝癌外科手術及介入治療提供有價值的信息。 材料與方法 收集2012年4月-2012年12月在泰安市中心醫(yī)院應用128層MDCT行強化掃描的病人共691例（男472人；女219人；平均年齡59歲），對其進行回顧性分析。圖像質量根據順序量表進行分級。所有病例的薄層圖像均使用最大密度投影（MIP）、容積再現（VR）后處理技術進行圖像分析及后處理。根據Michels分型將肝動脈解剖進行分類，并與國內外四組數據進行比較。將肝臟II、III、IV段及肝右葉的肝動脈依據肝段動脈的起源與走形不同進行詳細分類，并統計其發(fā)生率，分析各種類型的特點及規(guī)律，進一步闡明熟悉肝動脈解剖變異在肝癌手術及介入治療中的意義。 結果 691例患者中，103例（14.91%）由于圖像質量欠佳被排除。剩余的588例患者中（男性396人，女性192人；年齡范圍，22-94歲；平均年齡，59歲），檢測出肝動脈解剖變異數137例（23.30%），與經典的Michels研究數據比較，有統計學意義（P＜0.05）。 與國內外4組同類數據進行各種分型的比較，并通過總結國內外文獻提出的對肝動脈變異的各種分型，提出新的分型，對肝動脈分型進行完善和補充。 將肝癌組中行介入治療的患者的CTA資料與DSA資料進行對比，結果無統計學差異（χ2=0.003， P值=0.960＞0.05）。 根據對588例數據中肝II、III段動脈的觀察將肝II、III段動脈依據其是否來源于正常的肝左動脈分為兩大類，即第一類Normal LHA和第二類Variant LHA，分別稱為S2-Normal LHA型、 S2-Aberrant LHA型/S3-NormalLHA型、S3-Aberrant LHA型，其發(fā)生率分別為82.65%（486），17.35%（102），82.65%（486），17.35%（102）。其中S2/S3-Normal LHA型又被分為7個亞型，S2/S3-Aberrant LHA型分為6個亞型。肝Ⅳ段動脈（A4）依據其供血動脈的起源及數目分為五型，即LHA型、RHA型、PHA型、Dual型和Tri型，，各型發(fā)生率分別為56.12%（330）、28.57%（168）、2.21%（13）、12.76%（75）、0.34%（2）。肝右葉供血動脈依據其血管走形分為7種類型（用阿拉伯數字表示，分別為1、2、3、4、5、6、7、8型），其發(fā)生率分別為43.54%（256）、15.14%（89）、15.31%（90）、1.7%（10）、2.89%（17）、6.29%（37）、13.95%（82）、1.19%（7）。 結論： 結果表明，128層MDCTA在分析肝動脈解剖方面有重要意義，可以獲得與DSA類似的顯影效果。肝動脈解剖變異在受檢人群中具有相當高的發(fā)生率(23.30%)，其變異類型復雜多樣，但有一定的規(guī)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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