三维CTAP对右肝静脉与右门静脉关系的研究

目的观察右门静脉第3级分支与右肝静脉的前后关系,阐明右肝静脉是否与右纵裂相一致,能够作为右前段和右后段的分界标志。方法观察连续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)影像并行三维重建,对清楚显示右门静脉与右肝静脉关系的69例,对照观察三维CTAP和轴位CTAP影像。结果右门静脉第3级分支与右肝静脉关系的分析表明,在S8与S7之间近右膈顶的部分,右纵裂多数(54/64,84%)位于右肝静脉之背侧;在S5与S6之间,右纵裂经常(46/69,67%,约2/3)位于右肝静脉的腹侧。结论右肝静脉不是可靠的分界右前段和右后段的标志。门静脉的第3级分支是确定肝段的关键标志,提示应以门静脉第3分支P5～P8确定相应的肝段S5～S8,避免以右肝静脉为标志对肝段或肝肿瘤的错误定位。

The Relationship of Right Hepatic Vein and Right Portal Vein: Observation with Three -dimensional Helical CT Arterial Portography

Objective To analyse the relationship of right hepatic vein(RHV) and the third order branch of right portal vein (RPV) and to evaluate the correspondance of RHV with right scissura and the reliability of RHV used as the boundary between right anterior segment and right posterior segment. Methods Three-dimensional images were reconstructed in 100 patients undergone helical CT arterial portography(CTAP),of which,69 cases with good demonstration of relationship between RHV and RPV were assessed by comparison with continous axial CTAP images . Results In most of patients ( 54/64 ,84% ) the right scissura was dorsal to RHV between S8 and S7 under the right diaphragmatic dome, and that right sicssura was often ( 46/69,67% , about two thirds of cases ) ventral to RHV between S5 and S6 . Conclusion RHV is not a reliable landmark for the boundary of right anterior segment and right posterior segment. Thus, the third order branchof portal vein is the key landmarks for segmental location of liver. The observation of the third order branch of portal vein is useful todetermine their correspondent hepatic segment.