肝动脉及门静脉三维CT血管造影在肝移植肝门血管重建中的意义

目的 评价肝动脉、门静脉双期多层螺旋CT扫描及三维CT血管造影（3DCTA）在肝移植肝门血管重建术式选择中的应用价值。方法 25例拟行肝移植的受者进行肝动脉及门静脉双期3DCTA，根据术前3DCTA所显示的肝门血管情况，初步计划术中肝门血管重建方案，最后与实际手术情况相比较。结果 25例肝移植受者中15例为正常肝动脉解剖；10例有肝动脉解剖变异，占40％，其中以替代肝右、替代肝左、副肝左和副肝右动脉血管变异出现的情况居多。变异组中1例经DSA间接门静脉造影证实为门静脉海绵样变而放弃肝移植手术。其余24例接受肝移植手术的受者中，1例合并脾动脉瘤，术中行脾动脉结扎脾切除术；1例腹腔干起始部狭窄，3例经术前CT测量发现受者肝脏主要供养动脉直径〈3mm，上述4例患者接受肝-主动脉间移植架桥血管重建供肝血供。1例有门静脉主干内血栓形成，术中门脉取血栓术后行标准门脉吻合。经DSA及手术证实，3DCTA对肝门区血管诊断符合率达100．0％；术前根据CTA预制定的手术方案和术中实施方案相比，符合率正常肝动脉解剖组可达93．3％（14／15例），肝动脉变异组可达77．8％（7／9例）。结论 3DCTA能准确评价肝门区血管的变异和病变情况，对于术前准确合理地预制定肝门重建方案及术中准确快速地进行肝门血管吻合有着重要的意义。

Impact of three-dimensional CT angiography on surgical hepatic hilar vessel reconstruction planning for hepatic transplantation

Objective To assess the per fo rmance of multislice CT (MSCT) three-dimensional CT angiography (3D CTA) for he patic hilar vascular findings in patients before hepatic transplantation and its impacts on surgical planning for hepatic transplantation. Methods Twenty-five patients scheduled for hepatic transplantation were exam ined with contrast-enhanced multiphase MSCT, and surgical hepatic hilar vessel reconstruction planning were made depending on the results of these 3D CTA image s. Then the planned surgical approach were evaluated with the actual surgical te chnique. Results Fifteen patients had conventional and 1 0 patients had nonconventional hepatic arterial anatomy in this group. One patie nt with portal vein sponge degeneration in nonconventional group gave up the ope ration, the other 24 patients received hepatic transplantation successfully. All hepatic hilar vascular findings in 3D CTA images were detected in the operation . One patient with splenic artery aneurysm had surgical ligation of the splenic artery and splenoectomy. One patient with celiac trunk proximal end stenosis and 3 patients with the diameter of main hepatic supply artery no more than 3 mm re ceived aortohepatic interposition grafts for arterial anastomoses. One patient w ith portal vein thrombosis underwent surgical resection successfully and standar d portal vein anastomoses as planned. Correlation between the actual surgical te chnique and the planned surgical approach was seen in 14/15 (93.3%) patients wit h conventional anatomy and in 7/9 (77.8%) with nonconventional anatomy. Conclusion MSCT 3D CTA is a useful, accurate and noninvasive tech nique which can provide image findings that have significant impacts on surgical planning for hepatic transplantation.