CAJ | 학술논문

目的探讨严重肝硬化患者肝实质、门静脉与肝静脉或肝后段下腔静脉在影像上的特征，评估经皮经肝肝内门体分流术(PTIPS)的可行性及安全性，为该技术的临床应用提供解剖依据。方法 50例经临床及影像证实的严重肝硬化患者，在多层螺旋CT(MDCT)上模拟PTIPS,选右侧腋中线第8或第9肋间为经皮穿刺点A点,门静脉右支主十远端为门静脉穿刺点B点，肝右静脉汇入下腔静脉处为肝静脉或下腔静脉穿刺点C点，门静脉主干起始处为D点。A、B、C 三点连线为经皮经肝穿刺道，C、B、D 三点连线即门体分流道。所有患者肝脏CT增强扫描后行MPR后处理，测量数据用x±s表示，并计算总体均数的95％可信区间。同时分析门静脉右支与肝后段下腔静脉、肝动脉及胆管的解剖关系。结果模拟穿刺针体内部分的长度（A-B-C长度）为(145.7±14.8) mm；穿刺针的弯度（A-B径线与B-C径线夹角）为(145.0±9.9)°；肝实质段分流道的长度（B-C长度）为(42.7±7.2) mm；当门静脉主干闭塞时，分流道长度（C-B-D长度）为(117.7 ±11.6) mm；分流道的角度（B-C径线与B-D径线夹角）为(108.5±5.9)°。50例患者中肝后段下腔静脉位于门静脉右支背侧者24例，位于同一平面者26例；肝右动脉及右肝管均位于门静脉右支腹侧。经门静脉右支穿刺肝右静脉或肝后段下腔静脉的路径中无大的动脉、胆管等重要结构。结论从解剖学角度分析，PTIPS具有可行性及安全性，通过量化穿刺针的长度、角度及分流道长度、角度，可为该技术的临床应用提供解剖依据。
목적 탐토엄중간경화환자간실질、문정맥여간정맥혹간후단하강정맥재영상상적특정，평고경피경간간내문 체분류술(PTIPS)적가행성급안전성，위해기술적림상응용제공해부의거。방법 50례경림상급영상증실적엄중간경화환자，재다층라선CT(MDCT)상모의PTIPS,선우측액중선제8혹제9륵간위경피천자점A점,문정맥우지주십원단위문정맥천자점B점，간우정맥회입하강정맥처위간정맥혹하강정맥천자점C점，문정맥주간기시처위D점。A、B、C 삼점련선위경피경간천자도，C、B、D 삼점련선즉문체분류도。소유환자간장CT증강소묘후행MPR후처리，측량수거용x±s표시，병계산총체균수적95％가신구간。동시분석문정맥우지여간후단하강정맥、간동맥급담관적해부관계。결과 모의천자침체내부분적장도（A-B-C장도）위(145.7±14.8) mm；천자침적만도（A-B경선여B-C경선협각）위(145.0±9.9)°；간실질단분류도적장도（B-C장도）위(42.7±7.2) mm；당문정맥주간폐새시，분류도장도（C-B-D장도）위(117.7 ±11.6) mm；분류도적각도（B-C경선여B-D경선협각）위(108.5±5.9)°。50례환자중간후단하강정맥위우문정맥우지배측자24례，위우동일평면자26례；간우동맥급우간관균위우문정맥우지복측。경문정맥우지천자간우정맥혹간후단하강정맥적로경중무대적동맥、담관등중요결구。결론 종해부학각도분석，PTIPS구유가행성급안전성，통과양화천자침적장도、각도급분류도장도、각도，가위해기술적림상응용제공해부의거。
Objective To investigate imaging features of the liver, portal vein and hepatic vein or transhepatic inferior vena cava in patients with severe liver cirrhosis in multidetector row computed tomography ( MDCT), and assess the feasibility, safety and clinical significance of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS). Methods Fifty patients with severe liver cirrhosis confirmed by clinical data and imaging examination were enrolled in this study. Simulation of intrahepatic portosystemic shunt by percutaneous transhepatic approch is as follows. The right midaxillary line (the eighth or ninth intercostal space) was selected as puncture point A the right branch of portal vein was puncture point B,transhepatic inferior vena cava was puncture point C, and the distal part of right portal vein was D. A-B-C connection is simulated as percutaneous transhepatic puncture tract, C-B-D connection is simulated as portosystemic shunt tract. After tri-phase contrast-enhanced CT scanning, postprocessing images through multiple planner reconstruction ( MPR ) were obtained. The data were indicated statistically by x ± s. And 95％ confidence interval for mean was calculated. Anatomic relationship among the right portal vein,transhepatic inferior vena cava, hepatic artery and bile duct were analyzed for all patients. Results The length of the needle (A-B-C) is ( 145. 7 ± 14. 8 ) mm. The curvature of the needle ( the angle of A-B line and B-C line) is ( 145.0 ±9.9)°. The length of transhepatic shunt tract (B-C) is (42.7 ±7.2) mm. The length of the shunt tract (C-B-D) is ( 117. 7 ±11.6 ) mm; The angle of the shunt tract ( the angle of B-C line and B-D line) is (1O8.5 ± 5.9)°. In 24/50 patients, transhepatic inferior vena cava locate in the dorsal of the right portal vein, in 26/50 patients they are in the same plane. In all patients, the right branches of hepatic artery and bile duct locate in the ventral of the right portal vein. Conclusion The procedure of PTIPS is feasible and safe. To quantify the length and angle of the needle and the length and angle of the shunt tract provides the anatomic basis for clinical application.