256排螺旋CT三维重建右半肝门静脉和肝静脉及其解剖关系的临床应用研究

doi:10.13418/j.issn.1001-165x.2023.2.06

中国临床解剖学杂志 ›› 2023, Vol. 41 ›› Issue (2): 150-155.doi: 10.13418/j.issn.1001-165x.2023.2.06

256排螺旋CT三维重建右半肝门静脉和肝静脉及其解剖关系的临床应用研究

周芮灵¹，李盈¹，黄迪情¹，赵增江¹，丁慧²，张慧³*，陈伟⁴

1.长沙医学院第一临床学院； 2.长沙医学院医学影像学院； 3.长沙医学院人体解剖学教研室，长沙 410219；
4.中南大学湘雅医院，长沙 410008

收稿日期:2022-02-16 出版日期:2023-03-25 发布日期:2023-04-11
通讯作者: 张慧，硕士，副教授，研究方向：临床应用解剖与断层解剖学，E-mail：huizhang0601@126.com
作者简介:周芮灵（2001-），女，湖北汉川人，临床专业在读本科，E-mail：1241669363@qq.com
基金资助:
湖南省大学生创新创业训练计划项目（湘教通〔2020〕191号-3928）；湖南省普通高等学校教学改革研究项目（湘教通[2021]298号-HNJG-2021-1056）；湖南省线下一流本科课程《断层解剖学》

Study on clinical application of 256-slice spiral CT in 3D reconstruction of anatomical relationship between the right hepatic portal vein and hepatic vein

Zhou Ruiling¹, Li Ying¹, Huang Diqing¹, Zhao Zengjiang¹, Ding Hui², Zhang Hui³*, Chen Wei⁴

1. The First Clinical College of Changsha Medical University, Changsha 410219, China; 2. College of Medical Imaging, Changsha Medical University, Changsha 410219, China; 3. Department of Human Anatomy, Changsha Medical University, Changsha 410219, China; 4. Xiangya Hospital, Central South University, Changsha 410008, China

Received:2022-02-16 Online:2023-03-25 Published:2023-04-11

摘要/Abstract

摘要： 目的应用256排螺旋CT行上腹部血管造影，描述右半肝门静脉与肝静脉的CT表现、两者解剖关系和肝分段的再定义，探讨其临床意义。方法随机收集100例受检者CT平扫及三期增强扫描图像，观察三维重建后右半肝门静脉分支、肝静脉属支的分布情况，并对相关数据进行统计学分析。结果门静脉分布情况：S5段分为4型，A型66%，B型10%，C型8%，D型16%；S6段分为6型，A型56%，B型15%，C型4%，D型17%，E型4%，F型4%；S7段分为3型，A型73%，B型23%，C型4%；S8段分为5型，A型67%，B型3%，C型2%，D型8%，E型20%。肝静脉分布情况：肝左静脉、肝中静脉、肝右静脉分别汇入下腔静脉有45%，肝左静脉与肝中静脉形成共干汇入下腔静脉有55%；36%出现肝右下后静脉，11%肝右静脉细小，由发达的肝中静脉代偿性引流右半肝；15%肝中静脉主干位于门静脉主干分叉处上方，41%肝中静脉位于Rex-Cantlie线右侧。肝静脉与门静脉解剖关系分为4型，以A型最多，占64%，D型最少，占3%。结论右半肝肝静脉和门静脉解剖形态复杂多样，门静脉主干变异时肝静脉与门静脉空间分布也随之发生改变，对肝个体化手术的顺利实施具有影像学指导意义。

关键词: 右半肝； , , 三维重建； , , 门静脉； , , 肝静脉； , , 解剖关系

Abstract: Objective To describe the CT features of the right hepatic portal vein and hepatic vein by upper abdominal angiography with 256-slice spiral CT, and to explore the anatomical relationship and the redefinition of liver segmentation, so as to explore its clinical significance. Methods One hundred cases who were randomly collected were examined with plain CT scanning and three-phase enhanced CT scanning. The distribution of right hepatic portal vein and the branches, hepatic vein and the branches after 3D reconstruction were observed, and the relevant data were statistically analyzed. Results The distribution of portal vein: S5 segment could be divided into 4 types. There were 66 cases of A type, 10 cases of B type, 8 cases of C type, and 16 cases of D type. S6 segment could be divided into 6 types, A type 56 cases, B type 15 cases, C type 4 cases, D type 17 cases, E type 4 cases, F type 4 cases . S7 segment could be divided into 3 types, A type 73 cases, B type 23 cases, C type 4 cases. S8 segment could be divided into 5 types, A type 67 cases, B type 3 cases, C type 2 cases, D type 8 cases, E type 20 cases. The distribution of hepatic vein: 45 cases of LHV, MHV and RHV were imported into IVC respectively. Fifty-five cases of LHV and MHV formed common trunk and were imported into IVC. IRHV was found in 36 cases, 11 cases of RHV were small with compensatory blood supply to the right liver by developed MHV. The main MHV trunk was located above the main bifurcation of the portal vein in 15 cases, and the MHV was located right of the Rex-Cantlie line in 41 cases. In this paper, the spatial position relationship between hepatic vein and portal vein was divided into four types. Type A has the most (accounting for 64%) and type D has the least (accounting for 3%). Conclusions The anatomical features of the hepatic vein and portal vein in the right part of the liver is complex and diverse. The spatial distribution of hepatic vein and portal vein also change when the main portal vein is mutated. It has imaging guiding significance for the smooth implementation of individualized liver surgery.

Key words: Right liver; , 3D reconstruction; , Hepatic portal vein; , Hepatic veins; , Anatomy relationship

中图分类号:

R322.4+7

周芮灵, 李盈, 黄迪情, 赵增江, 丁慧, 张慧, 陈伟. 256排螺旋CT三维重建右半肝门静脉和肝静脉及其解剖关系的临床应用研究[J]. 中国临床解剖学杂志, 2023, 41(2): 150-155.

Zhou Ruiling, Li Ying, Huang Diqing, Zhao Zengjiang, Ding Hui, Zhang Hui, Chen Wei. Study on clinical application of 256-slice spiral CT in 3D reconstruction of anatomical relationship between the right hepatic portal vein and hepatic vein [J]. Chinese Journal of Clinical Anatomy, 2023, 41(2): 150-155.

参考文献 21

[1]	刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读[J]. 肿瘤综合治疗电子杂志, 2021, 7(2): 1-13. DOI: 10.12151/JMCM.2021.02-01.
[2]	杨明, 黄缘, 魏来. 肝硬化终末期患者的治疗和管理[J]. 临床肝胆病杂志, 2021, 37(1): 31-35. DOI: 10.3969/j.issn.1001-5256.2021.01.007.
[3]	中国医师协会介入医师分会. 中国门静脉高压经颈静脉肝内门体分流术临床实践指南[J]. 中华肝脏病杂志, 2019, 27(8): 582-593. DOI: 10.3760/cma.j.issn.1007-3418.2019.08.002.
[4]	陈超, 黄尔炯, 吴伟. 经颈静脉肝内门体分流术在门脉高压性疾病治疗中的应用[J]. 肝胆胰外科杂志, 2019, 31(8): 459-463. DOI: 10.11952/j.issn.1007-1954.2019.08.004.
[5]	孟岩, 张健飞, 于胜波, 等. 肝段解剖及肝脏外科研究进展[J]. 中国医师进修杂志, 2011, 34(z1): 108-109. DOI: 10.3760/cma.j.issn.1673-4904.2011.z1.069.
[6]	Soyer P, DA Bluemke, Choti MA, et al. Variations in the intrahepatic portions of the hepatic and portal veins: findings on helical CT scans during arterial portography[J]. Ajr Am J Roentgenol, 1995, 164(1): 103-108. DOI: 10.2214/ajr.164.1.7998521.
[7]	Atri M, Bret PM, Fraser-Hill MA. Intrahepatic portal venous variations: prevalence with US[J]. Radiology, 1992, 184(1): 157. DOI: 10.1148/radiology.184.1.1609075.
[8]	范应方, 向飞, 蔡伟, 等. 基于三维可视化技术的右半肝门静脉3D分型及分段[J]. 南方医科大学学报, 2016, 36(1): 26-31. DOI: 10.3969/j.issn.1673-4254.2016.01.05.
[9]	魏卿. 肝脏右后段门静脉和肝静脉的分支类型及其变异[D]. 大连: 大连医科大学, 2012.
[10]	王岐本, 曾志成. 国人肝静脉[J]. 中国现代医学杂志, 2006, 16(17): 2619-2622. DOI: 10.3969/j.issn.1005-8982.2006.17.016.
[11]	张琳. 肝中静脉解剖及影像三维重建在活体肝移植中的应用[D]. 重庆: 重庆医科大学, 2009. DOI: 10.7666/d.Y1546464.
[12]	杨文哲. 数字医学技术在闭合性肝外伤诊治中的应用研究[D]. 广州: 南方医科大学, 2015. DOI: 10.7666/d.Y2910686.
[13]	王海彪, 胡元达, 俞海蛟, 等. 腹腔镜下肝门解剖技术在精准左肝叶切除术的应用[J]. 中华外科杂志, 2014, 52(1): 68-69. DOI: 10.3760/cma.j.issn.0529-5815.2014.01.017.
[14]	王莉, 薛雁山, 胡齐, 等. 肝右后下静脉的CT影像解剖学研究及其临床意义[J]. 中国医学影像学杂志, 2009, 17(1): 28-31. DOI: 10.3969/j.issn.1005-5185.2009.01.009.
[15]	唐敏, 杨尚文, 马一鸣, 等. 64排螺旋CT扫描数据基础上的门静脉和肝静脉三维解读及其解剖变异分析[J]. 中国临床医学影像杂志, 2013,24(5): 338-340, 356. DOI: 10.3969/j.issn.1008-1062. 2013. 05.009.
[16]	孙谊, 王崑, 包全, 等. 肝脏Ⅶ-Ⅷ段联合肝右静脉主干切除手术的安全性探讨[J]. 中华普通外科杂志, 2014, 29(3): 181-184. DOI: 10.3760/cma.j.issn.1007-631X.2014.03.006.
[17]	谭孝华, 杜成友, 杨祖奎. 肝中静脉在活体肝移植中的作用[J]. 国外医学外科学分册, 2005, 32(4): 267-270. DOI: 10.3760/cma.j.issn.1673-4203.2005.04.008.
[18]	吴军, 闫雪华. 肝硬化门脉高压症介入治疗进展[J]. 甘肃医药, 2011, 30(8): 474-476. DOI: 10.3969/j.issn.1004-2725.2011.08.009.
[19]	赵洪伟, 齐瑞兆, 岳振东, 等. 3367例经颈静脉肝内门体分流术的技术难点分析[J]. 中华消化外科杂志, 2016, 15(7): 689-695. DOI: 10.3760/cma.j.issn.1673-9752.2016.07.010.
[20]	沈柏用, 施源. 肝脏分段解剖的新认识[J]. 世界华人消化杂志, 2008, 16(9): 913-918. DOI: 10.3969/j.issn.1009-3079.2008.09.001.
[21]	Healey JE. Anatomy of the biliary ducts within the human liver; analysis of the prevailing pattern of branchings and the major variations of the biliary ducts[J]. Arch Surg, 1953, 66(5): 599. DOI: 10.1001/archsurg.1953.01260030616008.

256排螺旋CT三维重建右半肝门静脉和肝静脉及其解剖关系的临床应用研究

Study on clinical application of 256-slice spiral CT in 3D reconstruction of anatomical relationship between the right hepatic portal vein and hepatic vein

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 21

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	江剑宏, 段仁鹏, 李晓锋. 国人胆道三维重建解剖变异应用研究[J]. 中国临床解剖学杂志, 2024, 42(1): 1-4.
[2]	郭红志, 王瑜, 张加琪, 梁海彬, 马梓玮, 冯伟, 吴忧, 司子燚. 血管铸型结合CT三维模型评估先兆子痫胎盘血管结构[J]. 中国临床解剖学杂志, 2024, 42(1): 5-10.
[3]	李佳伟, 张静, 李灿然, 兰文杰, 籍庆余, 郭志勇, 张云凤, 刘启, 陈清威, 李筱贺. 蒙古族人群股骨近端解剖参数X线测量[J]. 中国临床解剖学杂志, 2024, 42(1): 11-16.
[4]	李琨, 张燕, 郭冉, 郝咪咪, 吴轩宇, 徐艺芳, 王超群, 马文童, 张灵淇, 杨宏宇, 李志军, 张少杰, 王星. 儿童及青少年枕颈角与后枕颈角数字化测量及其临床意义[J]. 中国临床解剖学杂志, 2024, 42(1): 17-20.
[5]	李文, 杨思艺, 黄蕾, 卿霁雯, 蒋松涛, 张磊. 基于MRI探讨Lisfranc韧带的形态学特点及临床意义[J]. 中国临床解剖学杂志, 2024, 42(1): 21-25.
[6]	李凡凡, 徐阳, 王晓旭. 紫草素调节Nrf2/HO-1信号通路对实验性大鼠肉芽肿性小叶性乳腺炎的治疗作用研究[J]. 中国临床解剖学杂志, 2024, 42(1): 26-32.
[7]	王兴航, 丁佳媛, 李放, 包翠芬, 阎丽菁. 人参皂苷Rg1通过抑制NLRP3炎症小体途径减轻氧糖剥夺/复供后小胶质细胞炎症反应[J]. 中国临床解剖学杂志, 2024, 42(1): 33-41.
[8]	程莹莹, 武建军, 蔡海燕, 焦旭文, 马江波, 丁银秀. 体外炎性诱导星形胶质细胞激活及功能分析[J]. 中国临床解剖学杂志, 2024, 42(1): 42-46.
[9]	祁志, 杨力, 贾秋叶, 陈浩伦, 段兆达, 吴春云. 依达拉奉经MAPKs通路对脂多糖激活的小胶质细胞Sirt3表达调控[J]. 中国临床解剖学杂志, 2024, 42(1): 47-53.
[10]	张晶晶, 王洪新. 黄芩苷通过PDGF/P38 MAPK信号通路对肺动脉高压大鼠的保护作用[J]. 中国临床解剖学杂志, 2024, 42(1): 54-58.
[11]	乐钦, 陈荣丽, 熊婧熙, 王婷怡, 蔡志恒, 易秋实, 曾心怡. 白芨多糖对大鼠跨区皮瓣choke区的影响[J]. 中国临床解剖学杂志, 2024, 42(1): 59-64.
[12]	李笑予, 张磊, 付磊, 李东波, 汪国友. 三步接骨法治疗Sanders Ⅱ型跟骨骨折的有限元研究[J]. 中国临床解剖学杂志, 2024, 42(1): 65-70.
[13]	吴研飞, 马剑雄, 卢斌, 王颖, 柏豪豪, 靳洪震, 马信龙. CT后处理技术重建CT值与终板抗压强度的相关性研究[J]. 中国临床解剖学杂志, 2024, 42(1): 71-76.
[14]	庄万强, 唐毅, 骆勇刚, 张辉. 关节镜联合胫骨高位截骨术对髌骨位置及髌股关节功能影响的早中期回顾性研究[J]. 中国临床解剖学杂志, 2024, 42(1): 77-82.
[15]	罗鹰, 窦伟誉, 吴小杭, 陈璟昆, 彭昌贵, 潘剑英 . 微创海马钢板内固定治疗跟骨骨折并发症的影响因素[J]. 中国临床解剖学杂志, 2024, 42(1): 83-88.