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目的探讨多层螺旋CT(MSCT)增强扫描及血管成像技术在诊断成人活体右半肝移植静脉流出道重建方式的价值。资料与方法2007年11月至2008年2月在本院接受不含肝中静脉的右半供肝活体肝移植手术患者16例。男10例,女6例,年龄36～63岁(平均49岁)。术中用冻存血管重建肝脏Ⅴ(V5)、Ⅷ(V8)段的肝中静脉粗大属支及右肝下静脉(IRHV)。重建模式及例数为:V5(n=1),V8(n=1),V5和V8(n=6),V5和IRHV(n=2),V5、V8和IRHV(n=6);16例受体重建血管29支。术后行MSCT三期增强扫描,并利用多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)技术行肝静脉血管成像。对移植肝静脉流出道进行动态观察,评价重建方式,随访11天～1个月。观察移植肝增强表现,记录受体术后2周及1个月血清总胆红素水平。结果成人活体右半肝移植重建肝中静脉属支的搭桥血管和右肝下静脉均得以显示,其中3支显影纤细,1支略窄,其余未见狭窄。移植肝淤血的肝段强化行为各异,术后1个月淤血程度减轻,受体血清胆红素水平降低。结论MSCT可以清晰显示重建肝中静脉属支的搭桥血管和右肝下静脉及血管走行和狭窄情况,有助于了解移植肝淤血程度,为临床治疗提供有用的信息。
Objective To investigate the value of multislice spiral CT (MSCT) contrast-enhanced scanning and angiography in the diagnosis of venous outflow tract remodeling in adult patients with right-sided liver transplantation. Materials and Methods From November 2007 to February 2008 in our hospital, 16 patients undergoing right liver transplantation without liver transplantation were enrolled. 10 males and 6 females, aged 36 to 63 years (mean 49 years). Intraoperative use of frozen blood vessels to reconstruct the liver Ⅴ (V5), Ⅷ (V8) section of the large hepatic vein genus and the right hepatic vein (IRHV). The reconstruction mode and the number of cases are: V5 (n = 1), V8 (n = 1), V5 and V8 (n = 6), V5 and IRHV (n = 2), V5, V8 and IRHV Sixteen recipients reconstructed 29 blood vessels. Postoperative MSCT enhanced scanning of the third phase, and the use of multiplanar reorganization (MPR), maximum density projection (MIP), volume rendering (VR) technology for hepatic vein angiography. Transplantation of hepatic vein outflow tract dynamic observation, evaluation of reconstruction, follow-up 11 days to 1 month. Observe the enhanced performance of transplanted liver, and record the level of serum total bilirubin 2 weeks and 1 month after the operation. Results All the patients underwent right-sided liver transplantation in adult patients undergoing reconstruction of the grafts of the middle hepatic vein and the right hepatic vein. Three of them developed slenderly, one slightly narrowed and the rest showed no stenosis. Transplantation of hepatic congestion liver segment intensified behavior, reduce congestion after 1 month, receptor serum bilirubin levels decreased. Conclusion MSCT can clearly show the circumflex artery and the right hepatic vein and the vessel stenosis in reconstruction of the hepatic vein branches, which helps to understand the degree of liver transplantation and provide useful information for clinical treatment.