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Purpose of using 64-MSCT three-dimensional reconstruction of normal liver blood vessels to explore the 64-MSCT in the hepatic artery, portal vein, hepatic vein, application and clinical significance; through 64-MSCT patients with liver disease and cirrhosis Child-Pugh A and B sub- -level group of the right branch of portal vein in patients with 1cm, 2cm liver vein, the right hepatic vein 1cm, 2cm, 3cm between analog puncture ways of measuring, in order to provide morphological data for clinical intrahepatic portosystemic shunt. Method 1 select cases 64-MSCT scan line on the abdomen of 153 cases (male 80, female 73 cases), the first plain, then by the median cubital vein injection of contrast agent, intelligent tracking technology (Smart Prep) abdominal continuous detection of aortic celiac trunk level, start the hepatic artery scan. And the resultant data in the GE ADW4.2 workstation to perform image processing. Select line abdominal 64-MSCT scan liver disease was checking group of 40 patients (10 males, 30 females); cirrhosis group, 14 patients (7 men, 7 females) met the inclusion criteria. The first unenhanced, and then by the median cubital vein injection of contrast agent, intelligent tracking technology (Smart Prep) continuous detection of abdominal aortic celiac trunk level, start two scans. And the resultant data in the GE ADW4.2 workstation to perform image processing. Results according to Michels genotyping methods 153 cases of check by the hepatic artery parting situation is as follows: ① The the I-type: 123 cases, accounting for 80.39% (123/153 Li); ② The II type: 3 cases, accounting for 1.96% (3/153 cases); ③ The type III: 4 Li, accounting for 2.61% (4/153 Li); ④ Ⅳ type: 3 cases, accounting for 1.96% (3/153 Li); ⑤ V type: 6 cases, accounting for 3.92% (6/153 Li) ; ⑥ VI type: Li, accounting for 1.30% (2/153 Li); ⑦ Ⅶ type: two cases, accounting for 1.30% (2/153 Li); ⑧ VIII type: no; ⑨ IX type: four cases, accounting for 2.61% (4 / 153 cases); ⑩ X-type: none. In addition, there are six cases, accounting for 3.92% (6/153) can not be classified as Michels' classification from the left hepatic artery from the celiac axis 2 cases, accounting for 1.30% (2/153); starting from the right hepatic artery superior mesenteric artery, left hepatic artery from gastroduodenal two cases, accounting for 1.30% (2/153); hepatic artery from the superior mesenteric artery in 1 case, accounting for 0.65% (1/153); left outer lobe artery, left medial artery from the common hepatic artery issued, accounting for 0.65% (1/153 patients). 2.153 cases of check by the hepatic portal vein genotyping results are as follows: ① a type: 128 Li, accounting for 83.66% (128/153 Li); ② The b-type: 12 cases, accounting for 7.84% (12/153 Li); (3) c-type: 12 Li, accounting 7.84% (12/153 cases); ④ d-type: none; ⑤ e type: 1 cases, accounting for 0.65% (1/153). 3.153 cases checks hepatic vein genotyping results are as follows: ① The three branches of type: 54 cases, accounting for 35.29% (54/153 cases); ② The left total dry type: 64 cases, accounting for 41.83% (64/153 cases); ③ left together in the dry-type: 32 cases, accounting for 20.91% (32/153 cases); ④ right total dry-type: 3 cases, accounting for 1.96% (3/153). 4. Intrahepatic portosystemic shunt entrance of the hepatic venous retrograde angle (via the internal jugular vein puncture pathway) was significantly greater than anterograde angle (via the femoral vein puncture route). In addition to the normal group with cirrhosis Child-Pugh A, B grade group ФMHV1, ФRHV1 differences (P lt; 0.05), and the remaining ФRPV1, ФRPV2, ФMHV2, ФMHV3, ФRHV2, ФRHV3 at no differences. Normal group, the right hepatic vein 1cm to 2cm at the hepatic vein at 1cm ~ 2cm diameter than cirrhosis Child-Pugh A, B grade group decreases rapidly. The 6 normal group with cirrhosis, Child-Pugh A and B grade group simulation puncture ways the distance DMHV2-RPV1 DMHV3 the-RPV1 DMHV3 the-RPV2 DRHV1-RPV1 between different. Either the normal group or cirrhosis Child-Pugh A and B grade group liver, the right hepatic vein 1cm, 2cm, 3cm and portal vein 1cm, 2cm between each puncture point distance DMHV1-RPV1 gt; DMHV2-RPV1 gt; DMHV3-RPV1, DMHV1-RPV2 gt; DMHV2-RPV2 gt; DMHV3-RPV2, DRHV1-RPV1 gt; DRHV2-RPV1 gt; DRHV3-RPV1, DRHV1-RPV2 gt; DRHV2-RPV2 gt; DRHV3-RPV2. 7. accordance with α = 0.05 standard that there is no difference between the angle between the normal group analog puncture pathway vertical line and the horizontal. Normal group were less than the average analog the puncture ways with the horizontal-vertical angle between the right hepatic vein and portal vein cirrhosis Child-Pugh A, B grade group. 8 α = 0.05 standard view that there is no significant difference between exports, entrance angle between the normal group with cirrhosis, Child-Pugh A and B grade group analog puncture pathways and hepatic veins. Conclusion 1. 64-MSCT and reconstruction method provides a new means for the anatomical study of the functional state of the living body morphology. 2. 64-MSCT three-dimensional reconstruction technique is an effective method for the accurate measurement of intrahepatic vessels in vivo functional state. The hepatic artery, hepatic vein, and portal vein in vivo functional state of anatomical information. Through the inferior vena cava - right hepatic vein retrograde puncture ways superior to the right hepatic vein anterograde pathways and hepatic vein Shun retrograde pathway. 4 the puncture pathway intrahepatic portosystemic shunt analog study helps to select the appropriate length and diameter of the stent. Normal group with cirrhosis, Child-Pugh A and B grade group hepatic vein, the right hepatic vein from the inferior vena cava at the entrance to 1cm, 2cm, 3cm right branch of the portal vein from the bifurcation of the 1cm 2 cm between analog puncture ways for values ??ФMHV1 ФRHV1 the DMHV2-RPV1 the DMHV3-RPV1 DMHV3-RPV2 DRHV1-RPV1 outside change differences. 6 intrahepatic portosystemic shunt analog puncture pathway entrance angle and exit angle change in the opposite direction, should be based on the needs of trade-offs.
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