| ObjectiveIn recent years,increasing operation such as TACE、LDLT,makes usdeeply research the intrahepatic and extrahepatic distribution of the livinghepatic artery.The study result of cadaveric hepatic artery is affected bycomposition、dose、time and speed of the injection drug and hepatic arterialatrophy of corpse.In contrast,the data from64-MSCTA is more authenticand reliable.On the other hand,the number of hepatic artery of remainscan’t be measured accurately for it’s tiny diameter out of the liver andsmaller diameter in the liver,so there are so much report about theanatomical type and variations of out part of the hepatic artery,and scantdata of the hepatic artery in the liver.Therefore, the study is to investigatethe outer anatomical type、variations and inner distribution of living hepaticartery with64-multi-slice computed tomography angiography（64-MSCTA）,to provide morphological information for the diagnosis andtreatment of disease related to liver.Materials and methods1.200non-illness adult livers were enhancedly scanned by64-MSCT, the hepatic artery stage data were used. The hepatic artery wasthree-dimensional reconstructed by GE ADW4.2workstation of CTmachine,distinguished the anatomy and variation of by Michels’classification.2.120non-illness adult livers were enhancedly scanned by64-MSCT,the hepatic artery stage data were used. The hepatic artery wasthree-dimensional reconstructed by GE ADW4.2workstation of CTmachine, LHA and RHA were observed, the correlated data were collectedand analyzed statistically.ResultsThe first part The outer anatomy and variation of the HAAccording to the Michels’ classification,200cases were ploted asfollowing,type Michels I:148cases(74.0%).52cases (26.0%) wereabnomal,in which,type MichelsⅡ(rLHA arising from left gastric artery):6cases(占3.0%); type Michels Ⅲ(rRHA arising from superior mesentericartery):13cases(6.5%); type Michels V(aLHA arising from left gastricartery):10cases(5.0%); type MichelsⅨ(common hepatic artery arisingfrom superior mesenteric artery):1case(0.5%); There were22hepaticartery anatomic variations which could not be included in theMichels’classification,8cases were three common hepatic arterybifurcation,1case was quadrifurcate,while right hepatic artery arising fromgastroduodenal artery occured in3.5of cases. The type of right hepatic artery arising from celiac artery were1.5of all,however,1case accessoryright hepatic artery arising from gastroduodenal artery.The second partSection one The CT study of LHAAccording to the Michels’ classification,120cases were divided intonomal type (87cases,72.5%) and abnomal type (33cases,27.5%),among thelatter,there were11cases that LHA variation.commonly,proper HA sentout LHAand RHA, as their separation angle was（68.68±21.27）°，the dataof normal type was （69.16±22.73）°,while the angle of abnormal type was（66.28±11.71）°(p＞0.05)；The main length of LHA was（42.37±26.59）mm, the data of normal type was（42.75±23.61）mm,as the number ofabnormal type was（41.27±34.26）mm（p＞0.05）;The main length of RHAwas （58.69±25.44）mm(compared with LHA, P＜0.05);The trunk lengthof LHA ranged from2.8mm to155.7mm. the inner diameter of thebeginning, midpoint and distal end were（3.06±0.70）mm、（2.82±0.68）mm、（2.78±0.65）mm,separately；95%CI of distal end was1.51mm to4.05mm.The number of components of LHA was（2.78±0.85）,the data ofnormal type was（2.90±0.62）,while the number of abnomal type was（2.41±0.64）(p＞0.05).The LHA could set out single stem,dimidiatebranch, trichotomous branch and quadripartite branch in the left halfliver.The probability of single stem was4.2%,in this style,the LHA was left endite lobe branch,which supplied the segment Ⅳ, while the left exite lobewas associated aberrant LHA.The classification of dimidiate branchaccounted63.3%,including three situation:(1) The LHA was separated intoleft endite lobe branch and the left exite lobe branch,the angle betweenthem was（42.34±23.21）°,the beginning point of left endite lobe branch tothe point of LHAwas（34.42±20.29）mm. the left exite lobe branch dividedinto left exite superior segmental branch and left exite inferior segmentalbranch,which accounting33.3%;(2)The LHA sent out left exite superiorsegmental branch and left exite inferior segmental branch,owning28.3%;(3)The LHA divided into left exite inferior segmental branch andleft endite lobe branch,as the left exite superior lobe was supplied byaberrant LHA,accounting1.7%.The type of trichotomous branch was LHAset out left exite superior segmental branch and left exite inferior segmentalbranch,then one of them sent out artery to segment Ⅳ(28.3%);The type ofquadripartite branch owning2.5%,including three condition(1)LHA first setout two arteries to segment Ⅳ,then sepatated left exite superior segmentalbranch and left exite inferior segmental branch;(2)LHA gradually issuedleft exite superior segmental branch、 left exite inferior segmental branchand left endite lobe branch,then the last one set out artery to segmentⅡ,moreover, aLHA supplied segment Ⅱ,too.(3)LHA separated into twobranches,one of them distributing to segment Ⅱ and Ⅳ,and the other onesupplying segment Ⅲ and Ⅳ;owing0.8%,respectively.The LHA set out branches to segment Ⅱ、Ⅲ、Ⅳ(64.2%),to segment Ⅱ、Ⅲ(28.3%).Variant LHA arising from left gastric artery,enter the liver substanceby the left edge of segment Ⅱ and Ⅲ,including three types:(1)type of lefthalf liver:aberrant divided into left endite lobe branch and left exite lobebranch,then, the latter separating left exite superior segmental branch andleft exite inferior segmental branch,accounting0.8%;(2)type of left exitelobe:variant LHA divided into left exite superior segmental branch and leftexite inferior segmental branch,owing5.0%;(3)type of left exite superiorsegmental branch:including two situation,one condition was that variantLHA only supplied segmentⅡ,the other situation was aberrant LHA set outtwo arteries to segment Ⅱ,accounting2.5%、0.8%,respectively.Section two The CT study of RHAThe main length of RHA were（58.69±25.44）mm,the number ofnormal type was（53.27±22.42）mm,as the data of abnormal type was（73.26±27.63）mm(p＜0.05); the inner diameter of the beginning,midpoint and distal end of RHAwere（3.61±0.77）mm、（3.33±0.72）mm、（3.21±0.65） mm,separately;The rate that artery of segment Ⅳoriginating from RHA was35.0%,the distance of this artery to thebeginning of RHA was（22.18±13.63）mm, and the inner diameter of theartery was（1.75±0.59）mm.The number of component of RHA was（2.70±0.85）,the data ofnormal type was（2.65±0.79）,while the number of abnormal type was （2.83±0.99）(p＞0.05).The RHA could set out dichotomy, trifurcation,quadrifurcation and quintafurcation in the right half liver.The type ofdichotomy branch owing75.8%,including two subtypes,(1):the RHAdivided into right anterior lobe branch and right posterior lobe branch,theangle between them was（72.70±20.40）°,as the number of normal typewas（74.67±19.60）°,and the data of abnormal type was （65.94±22.13）°(p＞0.05); the former one setting out artery of segment Ⅷ and Ⅴ,andthe latter one sending artery of segment Ⅶ and Ⅵ,accounting54.5%;(2):The RHA divided into right superior lobe branch and rightinferior lobe branch,the former one seting out artery of segment Ⅷ andⅦ,and the latter one sending artery of segment Ⅴ and Ⅵ, owing21.3%.Thetype of trifurcation branch was that RHA divided into right anterior lobebranch、right posterior lobe branch and caudate lobe branch(or rightsuperior lobe branch、right inferior lobe branch and caudate lobebranch),owing3.3%.The type of quadrifurcation branch accounted13.3%,which setting out four arteries to four segment of right half liver.Thetype of quintafurcation branch owed1.7%,which had a caudate lobe branchmore than the former type.Otherwise,there was1.7%of all that did notdisplay the artery of segment Ⅴ.The RHA divided into right anterior lobe branch and right posteriorlobe branch,the length、the inner diameter at the point and it’s95%confidence interval of right anterior lobe branch were（27.31±16.13）mm、 （2.41±0.67）mm、（1.10～3.71）mm,respectively.and the length、the innerdiameter at the point and it’s95%confidence interval of right posteriorlobe branch were（33.41±26.48）mm、（2.20±0.64）mm、（0.95～3.45）mm,separately.The right anterior lobe artery set out artery of artery ofsegment Ⅷ and Ⅴ,the length、the inner diameter at the beginning and it’sdistance to the beginning of RHA of artery of segment Ⅷ were（46.58±17.68）mm、（1.72±0.64）mm、（53.43±16.01）mm,while thelength、the inner diameter at the beginning and it’s distance to thebeginning of RHA of artery of segment Ⅴ were（50.94±18.22）mm、（1.35.0±0.50）mm、（51.29±14.77）mm.On the other hand,the rightposterior lobe artery sent artery of segment Ⅶ and Ⅵ,and the length、theinner diameter at the beginning and it’s distance to the beginning of RHAof artery of segment Ⅶ were（48.78±15.60）mm、（1.49±0.53）mm、（52.92±15.21）mm.as the length、the inner diameter at the beginning andit’s distance to the beginning of RHA of artery of segment Ⅵ were（59.18±18.98）mm、（1.52±0.59）mm、（51.04±15.04）mm.The right anterior lobe artery set out artery of segment Ⅷ andⅤ,and it was variable that the arterial branch number of the two segment.Itwas detected that the rate of two arteries of segment Ⅷ was19.2%,and theproportion of three arteries and four arteries were3.3%and3.3%,respectively;In contrast,the probility of two arteries of segment Ⅴwas20.8%,on the other hand,the rate of three arteries and four arteries of this segment was1.7%、0.8%,separately.The right posterior lobe artery setout artery of segment Ⅶ and Ⅵ,it was found that the proportion of twoarteries、three arteries and four arteries of segment Ⅵ were13.3%、3.3%、0.8%,separately.It was noteworthy that the rate of this segment supplied bysix arteries was0.8%;Otherwise,there were also two arteries(16.7%) orthree arteries（1.7%）to segment Ⅶ.Conclusions1.64-MSCTA has the ability to provide accurate living morphologicalinformation of the HA.2.The HA variation was comlex,and it was beneficial to the clinicalwork to divide the HAby the origin and distribution.3.It was complicated that the branch and distribution of the LHA in theleft liver,and the LHA gave priority to dimidiate branch(left endite lobebranch and left exite lobe branch),mainly supplying segment Ⅱ、Ⅲ、Ⅳ; theangle between left endite lobe branch and left exite lobe branch are mainlyacute,and the sex difference、HA variation have no statistical significanceto it.4. It was complex that the branch and distribution of the RHA in theright liver, the RHA gave priority to dimidiate branch(right anterior lobebranch and right posterior branch), and the angle between them are mainlyacute angle, as the sex difference、HA variation have no statisticalsignificance to it.However, it is rather remarkable that21.3%of RHA are divided into right superior lobe branch and right inferior lobe branch,as theformer one sets out arteries to segment Ⅷ and Ⅶ,while the latter one sentarteries to segment Ⅴ and Ⅵ.5.The research is short of the relationship between variant HA andportal vein,which needs to intensive study in the future. |
PDF Full Text Request