目的 分析门静脉系统三维解剖结构及其与左侧结直肠癌肝转移灶分布的关系。
方法 选取2009年11月至2012年9月期间笔者所在医院行上腹部CT检查的181 例患者作为研究对象,观察其CT影像学资料并重建门静脉系统三维图像,进行门静脉系统解剖结构分型,并分析其中61例左侧结直肠癌伴肝转移患者的CT或MR二维图像及其临床资料,记录肿瘤原发部位,观察肝转移病灶的位置、数目以及门静脉系统的解剖类型。
结果 肠系膜上静脉(SMV)和脾静脉(SV)汇合成门静脉主干(MPV),在肝门处分为门静脉右支(RPV)和门静脉左支(LPV) 进入肝脏(A型)者占83.98% (152/181),其中肠系膜下静脉(IMV)汇入SMV (A1亚型) 65例 (35.91%),IMV汇入SV (A2亚型)64例(35.36%),IMV汇入门静脉角(A3亚型) 23例(12.71%);其他变异(B、C和D型)者29例,占16.02%。61例左侧结直肠癌伴肝转移患者中,IMV汇入门静脉角者12例,其肝转移灶均分布在肝左右叶(100%);而IMV汇入SMV或SV者49例,其肝转移灶分布在肝左右叶者30例(61.22%),分布在肝左或右叶者19例(38.78%),两种IMV汇入门静脉类型其肝转移灶分布构成比的差异有统计学意义(P<0.05)。在39例IMV汇入SV的患者中,肝内门静脉为2支型(A2亚型)者28例,其肝转移灶分布在肝左右叶者21例(75.00%),分布在肝左或右叶者7例(25.00%);而肝内门静脉为3支型(B2+C2亚型)的11例中,肝转移灶分布在肝左右叶者3例(27.27%),分布在肝左或右叶者8例(72.73%),两者的肝转移灶分布构成比的差异也有统计学意义(P<0.01)。
结论 门静脉系统的解剖结构复杂多变,与左侧结直肠癌肝转移病灶的分布密切相关。
Citation:
黄从云,孙俊旗,张俊安,朱剑华,刘欣,刘干辉,张小龙,赵家锋,吴青松. Three-Dimensional Classification of Portal Venous System and Its Relationship with The Distribution of Left-Sided Colorectal Liver Metastasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(10): 1159-1161. doi:
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- 1. Konopke R, Distler M, Ludwig S, et al. Location of liver meta-stases reflects the site of the primary colorectal carcinoma[J]. Scand J Gastroenterol, 2008, 43(2): 192-195.
- 2. Shirai Y, Wakai T, Ohtani T, et al. Colorectal carcinoma metas-tases to the liver. Does primary tumor location affect its lobar distri-bution?[J]. Cancer, 1996, 77(11): 2213-2216.
- 3. Holbrook RF, Rodriguez-Bigas MA, Ramakrishnan K, et al. Patterns of colorectal liver metastases according to Couinaud’s segments[J]. Dis Colon Rectum, 1995, 38(3): 245-248.
- 4. 田韧. 大肠癌肝内转移灶分布研究[J]. 中华消化杂志, 1998,.
- 5. 任黎, 蔡成机, 詹绍康. 结直肠癌发生部位与肝转移分布的关系[J]. 外科理论与实践, 2006, 11(1): 46-47.
- 6. 白娇, 张歌, 周印, 等. CT图像上结直肠癌肝转移灶的分布特点[J]. 中国普外基础与临床杂志, 2012, 19(11): 1238-1242.
- 7. Wigmore SJ, Madhavan K, Redhead DN, et al. Distribution of colorectal liver metastases in patients referred for hepatic resection[J]. Cancer, 2000, 89(2): 285-287.
- 8. 张书琴, 靳仕信, 张万盛. 门静脉及其属支的观察[J]. 遵义医学院学报, 1980, 3(1):78-83.
- 9. Atri M, Bret PM, Fraser-Hill MA. Intrahepatic portal venous variations:prevalence with US[J]. Radiology, 1992, 184(1): 157-158.
- 10. Uchida K, Taniguchi M, Shimamura T, et al. Three-dimensionalcomputed tomography scan analysis of hepatic vasculatures in the donor liver for living donor liver transplantation[J]. Liver Transpl, 2010, 16(9): 1062-1068.
- 11. Covey AM, Brody LA, Getrajdman GI, et al. Incidence, patt-erns, and clinical relevance of variant portal vein anatomy[J]. AJR Am J Roentgenol, 2004, 183(4):1055-1064.
- 12. Akgul E, Inal M, Soyupak S, et al. Portal venous variations. Prevalence with contrast-enhanced helical CT[J]. Acta Radiol, 2002, 43(3): 315-319.
- 13. Koç Z, Oğuzkurt L, Ulusan S. Portal vein variations:clinical implications and frequencies in routine abdominal multidetector[J]. CT Diagn Interv Radiol, 2007, 13(2):75-80.
- 14. Sakaguchi T, Suzuki S, Morita Y, et al. Analysis of anatomic variants of mesenteric veins by 3-dimensional portography usingmultidetector-row computed tomography[J]. Am J Surg, 2010,.
- 15. (2): 99-100.
- 16. (1): 15-22.