中晚期肝癌患者肝动脉解剖变异的数字减影血管造影观察及意义

目的分析中晚期肝癌患者直接参与肿瘤供血的变异动脉起源及分布情况,为介入治疗提供指导。方法回顾性分析351例中晚期肝癌患者肝动脉数字减影血管造影(DSA)资料,观察直接参与肿瘤供血的变异动脉起源及分布情况。结果 351例肝癌患者中63例(17.9%)变异动脉直接参与肿瘤供血。其中变异动脉起源于胃左动脉4例(6.3%),起源于肠系膜上动脉46例(73.0%),起源于肝总动脉1例(1.6%),起源于腹腔干6例(9.5%),起源于腹主动脉3例(4.8%),起源于胃十二指肠动脉3例(4.8%)。结论直接参与肝癌瘤体供血的变异动脉起源、分布有一定特点。肝右叶肿瘤直接供血的变异动脉常起源于肠系膜上动脉,肝左叶肿瘤直接供血的变异动脉常起源于胃左动脉。     

供肝切取修整及肝动脉损伤的预防

目的探讨供肝切取修整的方法,提高供肝质量和利用率,熟悉肝动脉常见变异,预防供肝切取修整过程中肝动脉损伤.方法回顾性分析2005年1月～2006年4月共计128例供肝切取修整及肝动脉变异资料,供肝采用肝肾联合切取方法,腹主动脉插管灌注,胰腺下肠系膜上静脉外科干插管门静脉灌注.结果采用此方法切取供肝128例,供肝及供肾的灌注及保存良好,其中3例同时完成心脏切取,1例同时完成心肺切取,未发生移植肝原发无功能.发现11例肝动脉变异.切取及修整过程中未出现肝动脉、肾动脉损伤.结论原位腹主动脉插管动脉灌注、肠系膜上静脉外科干处插管可保证供肝、供肾的质量,缩短热缺血时间, 降温迅速,灌注充分;可以减少直接对肝十二指肠韧带分离或劈开胰腺组织造成的变异动脉损伤;不影响心、肺、胰腺、脾脏等其它器官同时切取;提示肝动脉变异的少见类型,避免肝动脉损伤的发生.     

结肠上区血管明显变异一例

笔者在解剖一具约 14岁女尸时 ,发现结肠上区血管明显变异 ,详见图 1。 1腹腔干只发出两大分支 :脾动脉 ,沿胰背侧面上缘左行至脾门。胃左动脉在本干达到胃小弯前尚发出 3～4支细小的异常肝左动脉 ,经肝的脏面左纵沟前方进入肝左叶。 2肝总动脉缺如 ,在距腹腔干下方 5 6 mm处由腹主动脉直接发出异常胃右动脉 ,外径 2 .8m m,经追踪其尚发出胃十二指肠动脉及胃网膜右动脉。 3变异肝右动脉来源于肠系膜上动脉 (其距胃右动脉根部 75 mm ) ,且在肝十二指肠韧带内走行异常 ,肝门静脉居左前方 ,胆总管居右前方 ,其在二者后方走行 ,追踪至肝门 ,除发…     

肝动脉解剖变异的多层螺旋CT血管成像

目的评价多层螺旋CT血管成像(MSCTA)对肝动脉解剖变异显示的价值。方法回顾性分析81例行肝脏双期增强扫描图像资料并对图像进行重组,结合横断面、最大密度投影(MIP)、多平面重建(MPR)及容积再现(VR)观察其中8例患者的肝动脉解剖变异。结果8例(9.88%)患者变异的肝动脉均得到清晰显示,其中4例(占4.94%)肝总动脉来自肠系膜上动脉,3例(占3.70%)为替代肝右动脉来自肠系膜上动脉,1例(占1.24%)为腹腔干与肠系膜上动脉共干。结论MSCTA可以清晰显示肝动脉的解剖变异,为临床提供充分信息,应作为上腹部手术前的常规检查。     

腹部多器官联合切取的技术改进

目的:探讨腹部多器官联合切取与保存的技术改进经验。方法:采用腹部多器官联合切取技术,首先原位灌注腹主动脉,其次于肝十二指肠韧带内,十二指肠上缘分离出门静脉主干并插管灌注,整体切取腹部肝、双肾和胰腺并保存48例。结果:48例获取器官的热缺血时间是(3.4 ± 1.8) min,肝脏的冷缺血时间是(8.1 ± 4.3) h,发现肝动脉变异3例,起源于胃左动脉的变异肝左动脉1例,起源于肠系膜上动脉的变异肝右动脉2例,腹腔干和肠系膜上动脉共干1例,双支肾动脉2例,未发生血管损伤和输尿管损伤,48例供肝的组织学检查43例为正常肝组织表现,5例为轻度脂肪肝表现,行改良背驮式肝移植48例,所有病例均于无肝期结束开放血流后胆总管有金黄色胆汁流出, 无原发性移植肝无功能,2例移植后胆道并发症,96例肾移植后患者恢复顺利。结论:采用腹部多器官联合切取是保证器官有效利用的重要前提,快速切取技术是器官移植的重要保证。     

腹腔动脉的X线解剖学研究及临床意义

目的研究分析腹腔动脉的X线解剖,旨在指导介入治疗.方法对186例肿瘤病人在介入治疗前行腹腔动脉数字减影血管造影(digital subtraction angiography,DSA),其中行肠系膜上动脉DSA 21例.结果腹腔动脉开口位于第12胸椎与第1腰椎平面.由腹腔动脉干分为胃左、脾及肝总动脉三支者占92.4%,发现有47个分支有正常变异.肝固有动脉走行与肝总动脉呈钝角86.1%,肝固有动脉走行与肝总动脉呈锐角13.9%,胃十二指肠动脉与肝总动脉呈钝角67.5%,胃十二指肠动脉与肝总动脉呈锐角32.5%.脾动脉形态常见为上弧型、下弧型、水平、上升型、水平上升型等,少见为波浪型、回旋型.结论腹腔动脉及其分支的X线观察,对肝癌、胃癌等介入治疗具有很重要的意义.     

80例成人肝移植的供肝动脉变异、损伤与植入前重建

目的研究供肝肝动脉变异、取修肝损伤与植入前重建的相互关系,对动脉并发症的影响。方法回顾分析2004年3月至2006年7月单个医疗组完成的80例成人肝移植资料。植入前供肝动脉重建方法:整形获得变异或受损动脉的根部袖片或斜面端口,与合适部位吻合成具有共同主干的动脉树,尽可能单次吻合。3mm以下吻合口采用8/0prolene线间断缝合,3mm及以上吻合口采用7/0prolene线四点连续锁边缝合。术后以彩色多普勒超声、CT或MRI动脉造影监测动脉血流情况,随访6～34个月。结果供肝动脉变异发生率25.0%(20/80),变异肝左动脉6.25%,变异肝右动脉12.50%,二者并存3.75%,变异肝总动脉2.50%。全组取修肝动脉损伤发生率7.5%(6/80),变异组与无变异组损伤发生率(25.0%vs1.7%)有统计学差异(P<0.01)。损伤部位以变异肝右动脉损伤最为常见,占42.9%(3/7),占变异组损伤部位的50.0%。损伤时间在取肝、修肝期各占一半(3/6),变异组损伤的60.0%(3/5)发生在修肝期,无变异组未发生修肝损伤。取肝期动脉损伤率,在变异组与无变异组间(10.0%vs1.7%)存在统计学差异(P<0.05)。全组植入前动脉重建率13.8%(11/80),变异组为55.0%(11/20),76.9%的变异肝右动脉接受了植入前重建,均来自肠系膜上动脉。无变异组未行重建。动脉重建组中,63.6%(7/11)的变异/损伤动脉与脾动脉吻合。随访期内,全组无肝动脉血栓形成,肝动脉狭窄发生率3.8%(3/80)。变异组与非变异组肝动脉狭窄发生率(5.0%vs3.3%)比较,植入前重建组与非重建组(9.1%vs2.9%)比较,均无统计学意义(P>0.05)。全组假性动脉瘤发生率1.25%,吻合口出血发生率1.25%,均在无变异组。结论肝右动脉变异是供肝动脉变异的最常见类型,常需要植入前整形重建。供肝动脉变异增加取肝、修肝过程的动脉损伤发生率,本组变异肝右动脉损伤最常见。供肝动脉变异、合适的植入前重建并不增加移植后肝动脉血栓形成、动脉狭窄的发生率。     

腹腔动脉变异一例报告

笔者在解剖1例成年男性尸体时,见腹腔动脉变异.脾动脉起至腹主动脉.无肝总动脉,肝左动脉直接起于腹主动脉,肝右动脉则起自肠系膜上动脉.胃左动脉自肝左动脉远侧段发出.胃十二指肠动脉则由脾动脉分支,并发出肝中动脉.查阅文献见这种变异较少见[1],本文详细描述腹腔动脉分支及其次级分支的来源、行程,并用游标卡尺测量各动脉长度和外径.现报道如下.     

腹腔动脉变异二例

我们发现2例变异的腹腔动脉均为胃左动脉与脾动脉共干,肝动咏异常,现报告如下:例1,12岁,男尸。腹腔动脉仅为胃左动脉和脾动脉的合干,发自腹主动脉,干长0.7cm,胃左动脉和脾动脉分出后无异常。此干下方0.8cm 处腹主动脉又发一肠系膜上动脉与肝动脉的合干,干长2.5cm,分为肠系膜上动脉和肝动脉。肝动脉经门静脉后方返向上达肝门。沿途分出胃右动脉和胃十二指肠动脉。胆囊动脉由肝右支发出,其他无异常。例2,约30岁,男尸,腹腔动脉也为胃左动脉和脾动脉的合干,直接发自腹主动脉,干     

观察140例肝总动脉在造影上的形态、分支及其对肝癌临床的意义

本文分析140例肝总动脉在造影血管相上的形态及其分支的变化.肝总动脉呈水平向右或微向上、下走行者121例(占86.43%);呈卷曲或成角弯曲走行者19例(占13.57%)。肝总动脉大多数起始于腹腔动脉(99.28%),仅1例(0.72%)起始于肠系膜上动脉。肝固有动脉有99.28%系肝总动脉的延续。肝右动脉有90.72%起源于肝固有动脉,但亦有13例(9.28%)异常起源于肠系膜上动脉.胃十二指肠动脉与肝总动脉走行相交呈钝角者占78.26%(108/138),呈锐角者占21.74%(30/138)。了解这些血管形态及其变异,对指导超选择肝动脉造影和术中肝动脉插管有很大帮助。     

腹腔干及肠系膜上动脉畸形患者共干部真性动脉瘤的诊断与治疗

目的探讨腹腔干、肠系膜上动脉畸形共干部真性动脉瘤的诊断和手术治疗方法,总结手术中瘤体显露、切除以及血管重建的操作经验。方法回顾性总结1998年2月至2006年12月6例临床资料。均在全身麻醉下于腹腔干上方主动脉放置阻断带,游离并牵开胰腺体尾部,阻断共干部动脉瘤起始部和远端动脉分支,切除动脉瘤,缝扎腹腔干起始部和胃左动脉远端,分别行肾下主动脉与肝动脉、脾动脉、肠系膜上动脉人工血管转流术。结果行动脉瘤切除、肾下主动脉分别与肝动脉、脾动脉、肠系膜上动脉人工血管转流术5例,联合动脉瘤和脾脏切除、肠系膜上动脉成形、肾下主动脉与肝动脉人工血管转流术1例,术后恢复顺利,切口愈合良好,无肝脏、脾脏或肠管缺血等并发症,均获得临床治愈,随访观察1年2个月至8年。5例行主动脉-肝动脉、脾动脉和肠系膜上动脉转流者,均未发现吻合口阻塞或明显狭窄;1例主动脉-肝动脉转流、肠系膜上动脉成型者,手术后6个月和1年时均发现修复成型处略有狭窄,而主动脉和肝动脉吻合口通畅,随访1年2个月无肠管或肝脏缺血表现。结论在主动脉、共干腹腔干起始部及其分支阻断或控制下,切除腹腔干、肠系膜上动脉畸形共干部动脉瘤,同时行肾下主动脉与内脏动脉（肝动脉、脾动脉和肠系膜上动脉）人工血管转流术是治疗本病安全有效的的手术方法之一。     

Numerical variation of the celiac trunk and anatomical variation in origin and course of the dorsal pancreatic artery

A numerical anomaly of the celiac trunk and anatomical variation in origin, and course of the dorsal pancreatic artery were encountered during a routine upper abdomen dissection of a 62-year-old male cadaver. The aim of this study was to describe a rare celiac trunk and dorsal pancreatic artery variation in detail, which can be a guide and precaution during operative procedures in this region. The abdominal aorta, its branches and the pancreas were cut and removed just above the celiac trunk and below the superior mesenteric artery to investigate the vascular distribution of the pancreas in detail. The celiac trunk divided into the left gastric, hepatic, splenic, and dorsal pancreatic arteries. The anatomical variation of the celiac trunk and splenic artery makes it vulnerable to iatrogenic surgery. Knowledge of the existing aberrations is important in planning and conducting surgical procedures.     

肝动脉解剖变异在中晚期肝癌介入治疗中的意义

目的 探讨放射学肝动脉解剖变异及其在中晚期肝癌介入导管治疗中的临床意义。方法 回顾性分析125例中晚期肝癌肝动脉造影表现及其介入治疗资料。结果 125例中107例(85．6％)有典型肝动脉分布。肝动脉变异18例(14．4％)，其中肝右动脉变异10例(8％)，而又以肝右动脉始于肠系膜上动脉者最多，占6．4％。副肝左动脉变异1例(0．8％)。肝左动脉和肝右动脉同时变异2例(1．6％)。肝总动脉变异3例(2．4％)。胃十二指肠动脉起自肝右动脉和腹腔动脉各1例(1．6％)。对123例成功进行了肝动脉化疗栓塞，2例肝右动脉变异因角度关系超选插管未成功。结论 认识肝动脉解剖变异有助于提高插管的成功率和中晚期肝癌的介入治疗疗效。     

Rare variation of the celiac trunk and related review

In this study, we report a rare variation of the branching of the celiac trunk. During a routine abdominal dissection on a female cadaver, we found the celiac trunk to emerge from the abdominal aorta as 2 roots named hepatogastric trunk and hepatosplenic trunk. The hepatogastric trunk arises from the anterior surface of the abdominal aorta and divides into an aberrant branch to the right lobe of the liver, a branch to the right hemi diaphragm, the left hepatic and the left gastric arteries. The hepatosplenic trunk, which arises 1.5 cm below the hepatogastric trunk, gave off the common hepatic and splenic arteries. The common hepatic artery divided into the gastroduodenal, the right branch to the hepatic and the cystic arteries. It is important to know the variations of hepatogastric trunk and hepatosplenic trunk for the success of surgical operations to the liver and radiological investigations of those regions.     

Pseudo-occlusion of the anastomotic pathway between the celiac and superior mesenteric arteries in 15 cases

To study the causes and value of the pseudo-occlusion of the anastomotic pathway between celiac and superior mesenteric arteries. Methods: 15 patients including 12 patients with hepatocellular carcinoma and 3 patients with hepatic hemangioma underwent superior mesenteric arteriography (SMA) and celiac arteriography (CA) in interventional therapy. The angiographic features of the 15 cases were dynamically observed by 2 experienced radiologists in double-blind manner.Results: Similar interpretations were given by the 2 radiologists. In CA, pseudo-occlusion occurred at the bifurcation of the common hepatic artery and the celiac artery in 8 cases, at the bifurcation of the common hepatic artery and the gastroduodenal artery in 6 cases and at the bifurcation of the right hepatic artery and the celiac artery in 1 case. No occlusion was found in SMA and the angiographic wire and catheter could pass easily through the occluded regions seen in CA. Conclusion: Pseudoocclusion of the anastomotic pathway between the superior mesenteric and celiac arteries is rare phenomenon. Its cause was not identified in our cases. It may result from the hemodynamic change or abnormality of the hepatic artery. It is very important to understand the existence of pseudo-occlusion in order to guide the catheterization in interventional therapy.     

An anomalous case of the hepato-spleno-mesenteric and the gastro-phrenic trunks independently arising from the abdominal aorta

This report describes an arterial anomaly case in the celiaco-mesenteric region, which was encountered in a Japanese male cadaver in the dissecting room at Kurume University School of Medicine in 1999. In this case, the usual celiac trunk was not identified, and the hepato-spleno-mesenteric and the gastro-phrenic trunks were independently arising from the abdominal aorta. In addition, the common hepatic artery divided into the left hepatic, the right hepatic, and the gastroduodenal arteries simultaneously, then, the accessory gastric artery arose from the left hepatic artery. This type of arteral anomaly belongs to the Type III of Adachi's classification and the Type II of Morita's classification.     

285例腹腔动脉X线解剖分析

本文对285例腹腔动脉的 X 线解剖进行了分析.发现腹腔动脉开口于腹主动脉的左、正前壁者占88.1%;起始高度在第十二胸椎下份至第一腰椎上份之间者占76.8%;腹腔动脉主干直接分为胃左、脾、肝总动脉三大分支者占80.0%;发现39条肝迷走动脉,并有91条腹腔动脉主要分支存在变异.     

Multiple aberrant coeliac trunk ramifications

This study describes a routine educational cadaveric dissection, where multiple aberrant coeliac trunk branches were noticed. Specifically, the accessory left hepatic artery emerged from the left gastric artery, while the left inferior phrenic artery originated from the coeliac trunk. The accessory left suprarenal artery was found to commence from the coeliac trunk, whereas two aberrant left suprarenal arteries branched separately from the origin of the left inferior phrenic artery. Finally, the accessory jejunal artery was observed to originate from the coeliac trunk. Anatomical variations of the coeliac trunk branches can significantly alter the surgical management of the upper abdomen; hence, clinicians and radiologists should be aware of such aberrant vascular anatomy so as to reduce the incidence of surgical complications.     

肝动脉变异及其在肝癌介入治疗中的意义

目的:通过肝动脉造影观察肝动脉及其肝外分支的不同变异情况,为肝癌介入治疗提供影像学指导。方法:收集200例原发或转移性肝癌患者的介入术前肝动脉造影资料,2名介入科医生共同阅片观察Michels肝动脉变异分型,分析肝动脉变异发生概率、肝固有动脉缺失变异情况及肝动脉肝外分支的出现概率、起始部位的变异情况。结果:最常见的肝动脉变异是MichelsⅢ型17例（8.5%）,其次是Ⅱ型10例（5.0%）和Ⅴ型9例（4.5%）。Ⅰ型中肝固有动脉缺失25例,且发现5种亚型。肝外供血分支5种,最常见的是胃右动脉肝外供血分支156例（78.0%）,其次是胆囊动脉126例（63.0％）、副胃左动脉19例（9.5％）、肝镰状动脉5例（2.5%）、副左膈动脉4例（2.0％）。结论:肝动脉变异除Michels分型外尚有其他亚型,且肝动脉的肝外分支变异较多,充分认识这些变异有助于提高肝癌介入治疗效果,预防并发症发生。     

原发性肝癌的肝外动脉供血与介入治疗

目的 探讨原发性肝癌的肝外动脉供血规律,旨在指导介入治疗.方法 对本组25例原发性肝癌患者行常规腹腔动脉造影及肝癌肝外供血动脉探查,分别超选择插管及化疗栓塞(TACE).结果 25例患者共见27条肝外供血动脉,其中膈动脉供血7例,肠系膜上动脉供血10例,两者占多数.22条肝外供血动脉行超选择插管和化疗栓塞术,其余5条因未能超选择插管而只行化疗药物灌注治疗.结论 原发性肝癌的肝外动脉供血较为常见和多变,对肝外动脉供血支选择性栓塞治疗具有重要的临床意义.