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目的探讨多层螺旋CT动脉造影(MSCTA)对肝硬化脾功能亢进行部分性脾脏栓塞术治疗的指导意义。方法 2013年1月至2015年7月经临床、肝功能和影像学检查诊断为肝硬化脾功能亢进患者28例,脾脏部分栓塞术治疗前行多层螺旋CT肝区三期增强扫描,应用容积再现(VR)、多平面重组(MPR)和最大密度投影(MIP)对脾动脉及其分支三维重建,进行术前分析,术后与血管造影对比。结果所有患者的MSCTA均清晰显示脾动脉及其分支的起源、形态、走向,显示的血管与DSA血管造影相一致,28例脾动脉造影中,发现存在脾叶血管变异3例,1例胃短动脉自脾下叶动脉Ⅱ级分支发出,2例部分胃短动脉和胃网膜左动脉起自脾下叶动脉Ⅱ级分支,部分胃短动脉自脾上叶动脉Ⅱ级分支发出。部分性脾动脉栓塞术均顺利完成,术后未出现胰腺动脉误塞及变异血管栓塞并发症,术中7例患者采用了同轴微导管进行超选择插管栓塞治疗。结论多层螺旋CT脾动脉血管造影三维重建对指导制定介入治疗方案具有较高的实用价值。
Objective To investigate the significance of multislice spiral CT angiography (MSCTA) in the treatment of partial splenic embolization of liver cirrhosis and hypersplenism. Methods From January 2013 to July 2015, 28 cases of patients with cirrhosis and hypersplenism were diagnosed by clinical, liver function and imaging examination. Spleen partial embolization was used to treat the three-phase enhanced hepatic multi-slice spiral CT scan. Volume rendering Three-dimensional reconstruction of the splenic artery and its branches was performed by VR, MPR and MIP. Preoperative analysis and postoperative contrast angiography were performed. Results The MSCTA of all the patients clearly showed the origin, shape and direction of the splenic artery and its branches. The blood vessels showed the same as DSA angiography. In 28 cases of splenic artery angiography, there were 3 cases of splenic vascularisation and 1 case of shortness of stomach Arteries from the splenic artery of the second grade branches issued, 2 cases of part of the short gastric artery and the left gastric artery from the splenic artery of the second grade branches, some of the short gastric artery from the splenic artery branch issued. Partial splenic arterial embolization were successfully completed, no postoperative pancreatic arterial obstruction and variant vascular embolism complications, intraoperative 7 patients with coaxial microcatheter for the treatment of superselective catheterization. Conclusion Three-dimensional reconstruction of splenic artery angiography by MSCT has high practical value in guiding the development of interventional therapy.