多层螺旋CT对肝移植患者术前门静脉异常表现与手术相关性探讨

目的回顾分析多层面螺旋CT发现与手术证实的门静脉栓子或异常与原位肝移植手术操作的相关性.方法在150例原位肝移植中,门静脉异常35例,分别回顾手术纪录及CT图像表现,评价肝外门静脉通透性、海绵样变、静脉壁或栓子钙化.结果35例中,CT描述门静脉栓子28例、钙化1例、海绵样变4例、门脉分流术后2例、门静脉栓子在肠系膜上静脉与脾静脉汇合处以上2 cm 6例,栓子到肠系膜上静脉3例.20例进行栓子切除后直接进行门静脉端-端吻合,4例门静脉异常者亦行门静脉端端吻合,8例行栓子切除后行PV-PV吻合,3例行门静脉间置植片.结论多层面螺旋CT对原位肝移植术前评价门静脉及相应的手术计划制定是有帮助的.

Portal venous anomalies in liver transplantation candidates: preoperative MSCT findings and correlation with surgical procedure

Objective To review the multislice CT findings in patients with surgically proved portal venous (PV) thrombosis or calcification and to correlate these findings with the surgical procedure used at orthotopic liver transplantation (OLT). Methods Among 150 OLT's patients, PV thrombosis or calcification was found at surgery in 35 patients. Before OLT, surgical records and CT images were retrospectively reviewed in 150 patients with available CT studies. Patencies of the extrahepatic PV system were evaluated. Cavernous transformation, calcification of the venous wall and thrombus were recorded. Results CT depicted that 28 thrombus, 1 PV calcification and 4 cavernous transformation in 35 patients. The thrombus extended to or beyond the confluence of the splenic and superior veins in 6 and 3 patients, respectively. Of 35 patients, 20 underwent thrombectomy with direct PV-to-PV anastomosis and 3 had placement of venous grafts anastomosis. Conclusion Before OLT, MSCT is helpful in assessing PV and in surgical planning.