术前64排螺旋CT对腹腔镜胆囊切除术可行性的研究.docVIP

术前64排螺旋CT对腹腔镜胆囊切除术可行性研究 孔雀 陈军* 彭宙锋 杨文兵 李涛 査云飞 武汉大学人民医院放射科 武汉 430060 中国 *通讯作者：陈军 武汉大学人民医院放射科E-mail: lily_chenjun82@ 目的：用64排螺旋CT（64-row detectors multiple slices CT ,64-MSCT）对拟行腹腔镜胆囊切除术的病人进行术前评估，描述胆管及胆囊动脉解剖及变异，及影像所见与外科手术计划的关系。材料与方法：选择2009年2月至5月拟行腹腔镜胆囊切除术患者22名(男 12例，女 10例，26~56岁，平均年龄45岁)，进行术前64-MSCT检查，将检查结果经过后处理后与术中结果进行对比。结果：22例患者均获得满意的MSCT图像。其中20例患者获得满意的胆囊动脉显影图像，另外2例一例胆囊动脉未显示，一例胆囊动脉细小，在后处理中无法显示,其上肝门区有一海绵状血管瘤，与胆囊动脉联系较紧密；20例显影的胆囊动脉均为主干型，其中19例胆囊动脉走行于胆囊三角内，1例走行于胆囊管后方；22例患者中有19例胆囊管直接汇入胆总管，直接汇入肝总管右侧，1例胆囊管开口于肝总管左侧，于肝总管后方穿过进入Calot三角，1例胆囊管迂曲，1例胆囊管与肝总管平行走行，至十二指肠后段或胰腺后段始与肝总管汇合。22例患者中17例患者影像诊断为胆囊结石，5例患者影像诊断为胆囊炎，以上结论腹腔镜术中均证实。1例患者影像诊断为十二指肠占位压迫胆总管下段，直接转为开腹手术，术中证实。1例患者影像诊断为肝门区海绵状血管瘤，转为开腹，术中证实。结论：术前64-MSCT可以描绘胆囊动脉及胆道系统解剖，发现解剖变异，评估腹腔镜胆囊切除术可行性以及难易度。 关键词：胆囊切除术 腹腔镜 计算机体层摄影 胆囊动脉 胆囊三角 Preoperative 64-row detectors multiple slices CT evaluation of Laparoscopic Cholecystectomy Kong Que Chen Jun Peng Zhoufeng Yang Wenbing Li Tao Zha Yunfei Department of Radiology, Renmin Hospital of Wuhan University, Wuhan 430060, P.R.C Purpose: To depict the anatomy variation of the cystic arteries and the biliary system, and evaluate the feasibility of Laparoscope Cholecystectomy (LC) and the relevance between the images and the operation preoperative with 64-row detectors multiple slices CT (64-MSCT). Materials and Methods: A total of 22 consecutive patients (12 males, 10 females), who subsequently underwent LC, were examined from February 2009 to May 2009. The appearence of their MSCT were compared with the results that were seen in the surgical or LC operation. Results: The cystic arteries were delineated in 20 of the 22 patients. One cystic artery was seen in the Calot triangle in 19 patients, and one cystic artery was seen out of the Calot triangle in 1 patient. One cystic artery was not seen in 1 patient and one cystic artery above which Hilar cavernous hemangioma was seen next to it was very tiny in 1 patient of the other two There were 18 patients with cystic duct directly into t