肝脏CT影像解读分析系统在规范肝移植技术中的临床应用

目的分析肝移植术前应用肝脏CT影像解读分析系统研究肝静脉合干及其在下腔静脉注入的解剖与分布情况,按肝静脉解剖特征拟定肝移植的技术类型。方法统计武汉大学中南医院和中南大学湘雅三医院2000年5月至2007年8月期间共施行的248例背驮式肝移植患者的手术数据,并根据该248例患者的肝静脉解剖及其注入下腔静脉的数据对肝静脉类型进行分型并命名。另外收集武汉大学中南医院2010年3月至2013年4月期间实施的40例背驮式肝移植患者的术前肝脏CT影像解读分析系统的数据,分析每例患者的肝静脉在第二肝门合干及其注入下腔静脉的解剖情况,并分析肝短静脉在第三肝门注入下腔静脉的解剖情况,最后按笔者肝静脉分型标准在术前对肝脏CT影像解读分析系统的数据进行分型并拟定肝移植技术类型。结果 248例背驮式肝移植患者术中按肝静脉合干及其注入下腔静脉的解剖情况将肝静脉分为5型：Ⅰ型（左中肝静脉合干型）142例（57.25%）、Ⅱ型（右中肝静脉合干型）54例（21.77%）、Ⅲ型（左、中、右肝静脉共干型）14例（5.64%）、Ⅳ型（分别汇入型）34例（13.71%）〔其中ⅣA型16例（6.45%）,为同轴水平汇入;ⅣB型18例（7.25%）,为非同轴水平汇入〕、Ⅴ型（肝段型）4例（1.61%）。40例背驮式肝移植患者的术前肝脏CT影像解读分析系统的数据显示：Ⅰ型24例（60.00%）,Ⅱ型9例（22.50%）,Ⅲ型2例（5.00%）,Ⅳ型4例（10.00%）,Ⅴ型1例（2.50%）,肝脏CT影像解读分析系统的数据得出的肝静脉各型所占比例与笔者肝静脉分型标准中各型所占比例基本吻合。结论根据术前肝脏CT影像解读分析系统的数据确定肝静脉合干与非合干汇入肝后下腔静脉的解剖状况,从而按肝静脉分型标准归类后术前确定背驮式肝移植手术方式（Ⅰ、Ⅱ、Ⅲ型和ⅣA型可常规行经典式背驮式肝移植,ⅣB型和Ⅴ型仅能进行改良式背驮式肝移植或行经典式原位肝移植,亦可结扎或缝扎各肝静脉分支,在供、受体下腔静脉后、前正中行梭形切口或三角形开孔吻合）,为临床术前决策提供重要依据。

Clinical Study of IQQA Liver Image Analysis System on Liver Transplantation Technology Specification

Objective To study the anatomy and variations of hepatic veins draining into inferior vena cava（IVC）,and to classify the surgical techniques of piggyback liver transplantation（PBLT）based on the view of hepatic veins anatomy with IQQA liver image analysis system so as to provide the important basis for the perioperative clinical decision making.Methods Two hundred and forty-eight cases of PBLT were preformed in the Zhongnan Hospital of Wuhan University and the 3rd Xiangya Hospital of Central South University from May 2000 to August 2007,the types of hepatic veins were summarized according to the anatomy of hepatic veins and short hepatic veins draining into IVC at the second and third hepatic hilars.Forty cases of PBLT were preformed in the Zhongnan Hospital of Wuhan University from March 2010 to April 2013,and the anatomy of hepatic veins was reviewed with IQQA liver image analysis system.The anatomy of hepatic veins and technological type of liver transplantation were recorded respectively.Results Of these 248 livers studied in our center,type Ⅰ（the left and middle hepatic vein joined as one trunk）was found in 142 cases（57.25%）,type Ⅱ（the right and middle hepatic vein joined as one trunk）was 54 cases（21.77%）,type Ⅲ（three hepatic veins joined as one trunk）in 14 cases（5.64%）,type Ⅳ（the left,middle,and right hepatic veins were all unique） in 34 cases（13.71%）,and type Ⅴ（no hepatic veins but short hepatic veins）in 4 cases（1.61%）.The data of 40 cases of PBLT from IQQA liver image analysis system showed that typeⅠ were found in 24 cases（60.00%）,type Ⅱ in 9 cases（22.50%）,type Ⅲ in 2 cases（5.00%）,type Ⅳ in 4 cases（10.00%）,and type Ⅴ in 1 case（2.50%）,which were matched with hepatic vein classification standard of the author.Conclusions Studying the anatomy and variations of hepatic veins draining into IVC with IQQA liver image analysis system and classifying the surgical techniques of PBLT（typeⅠ,Ⅱ,Ⅲ,and ⅣA patients can be performed classical PBLT;Type ⅣB and Ⅴ patients can only be performed ameliorative PBLT）could provide an important basis for clinical preoperative decision.