三维CTAP对肝脏尾状叶腔静脉旁部的观察

目的描述和分析门静脉副前上支的走行和分布,并结合临床病例探讨其归属和临床价值。方法对连续100例门静脉显示良好无严重肝硬化的螺旋CT动脉性门静脉造影(CTAP)影像行三维重建,结合观察三维CTAP和连续轴位CTAP影像,对其中20例清楚显示一支较大的起自右前支的P点和A点之间,分布于右肝静脉和中肝静脉根部之间的区域称为门静脉副前上支(AASB)的分支,分析AASB与右前上内侧支P8d与门静脉尾状叶腔静脉旁支(PCPB)间的相互关系。同时回顾性复习14例经CTAP检查左门静脉横部栓塞或右前支栓塞的影像表现,进一步探讨AASB的临床意义。结果100例中有20例观察到有AASB存在。AASB与P8d同时存在的可能性明显小于AASB与PCPB或P8d与PCPB同时存在的可能性(Ρ<0.05),但后2组间同时存在的可能性无显著差别(P>0.05),推测AASB可能是变异的P8d。说明在20%的病例该区域肝实质的门静脉血供来自AASB。结论提示在解释该区域的影像表现和进行手术切除或栓塞治疗时应注意AASB的存在。

Observation of Paracaval Portion of the Caudate Lobe of Liver with Three-dimensional Helical CT Arterial Portography

Objective To describe and analyse the course and distribution of the accessory anterior superior branch(AASB) of portal vein by using helical CT arterial portography(CTAP),and to evaluate its belonging and clinical value by combining observation with clinical cases.Methods Three-dimensional images were reconstructed in sequential 100 patients undergone helical CTAP,of which 20 cases(20%) with a relatively large branch directly arising from right anterior branch between P-point and A-point which suppiled to the medial portion of S8 between the roots of right and middle hepatic vein was observed with combined observation of continous axial CTAP images.and was called AASB.Results by comparing the relationshp among AASB and medial branch of P8(P8d) and paracaval portion branch(PCPB) of caudate lobe,we inferred that AASB may be the variation of P8d.The result showed that in 20% of cases the area between the roots of right and middle hepatic vein was distributed by AASB.Conclusion The care of AASB should be taken in explaining the imaging findings and in doing surgical operation as well as subsegmental arterial chemoembolization.