肝动脉正常解剖及变异的DSA研究

目的 研究数字减影血管造影（DSA）下肝动脉正常解剖及变异。方法 回顾分析我院从1994年11月至2003年6月的1200份，常规腹腔动脉干造影和（或）选择性肝动脉造影DSA片，部分病例同时作肠系膜上动脉、胃左动脉等处的造影。结果 873例（72．8％）患者具有正常的肝血管起源，156例（13．0％）患者存在变异的肝左动脉，120例（10．0％）患者存在变异的肝右动脉，而21例（1．8％）肝左及肝右动脉同时存在变异。1200例患者中肝总动脉起源于腹腔动脉干者1170例（97．5％）；肝固有动脉有92．0％系肝总动脉的直接延续；肝右动脉大多数发自肝固有动脉（89．8％）；肝中动脉的变异较大，发自肝左动脉较多（62．2％）；肝左动脉可直接发自肝固有动脉（44．6％），也可来源于肝右动脉（30．2％）或其他动脉（25．2％）。结论 DSA了解肝动脉的解剖变异对指导肝脏疾病的介入治疗以及肝脏外科临床具有重要的意义。

DSA analysis of the normal and variant hepatic arterial anatomy

Objective To observe and analyze the normal and variant hepatic arterial anatomy by DSA.Methods One thousand and two hundreds patients with routine celiac and/or selective hepatic arteriography from November 1994 to March 2003 were retrospectively analyzed, some of them were further simultaneously undergone superior mesenteric arteriography, left gastric arteriography or inferior phrenic arteriography etc. Results 873( 72.8% )patients had the standard hepatic arterial anatomy. 156( 13.0% ) patients had variant left hepatic arteries(LHAs), 120( 10.0% ) with variant right hepatic arteries (RHAs) and 21(1.8%) of a variant anatomy involving both LHA and RHA. The common hepatic artery (CHA) of 1170 ( 97.5% ) patients originated from the celiac artery. 92.0% proper hepatic artery (PHA) was the direct extension of CHA. The RHA was mainly (89.8%) derived from the PHA. There was some variation of the middle hepatic artery(MHA) with more than 62.2% arising from the LHA. The LHA was derived from the PHA ( 44.6% ) or the RHA( 30.2% ) or other arteries ( 25.2% ).Conclusions The knowledge of normal and variant anatomr of hepatic vasculature by DSA may be very helpful for intervention therapy and hepatosurgery.