Nishio Hideki, Nagino Masato, Kamiya Junichi, Uesaka Katsuhiko, Oda Koji, Sano Tsuyoshi, Kanai Michio, Nimura Yuji
The First Department of Surgery, Nagoya University School of Medicine, 65 Tsurumaicho, Showaku, Nagoya 466-8550, Japan.
World J Surg. 2003 Apr;27(4):433-6. doi: 10.1007/s00268-002-6655-3.
The goal of this study was to determine which projection for percutaneous transhepatic portography best depicts the anatomy of the proximal portal vein. Portograms ( n = 47) obtained in the anteroposterior, right anterior oblique, and right anterior caudal oblique projections were analyzed retrospectively. Lengths of the right portal trunk, the transverse portion of the left portal vein, and the right anterior and posterior portal branches, as well as angles between the right portal trunk and the transverse portion of the left portal vein and between the right anterior and posterior portal branches were measured in the various projections. Differences were evaluated using analysis of variance with Scheffe's method. The transverse portion of the left portal vein and the right anterior and posterior portal branches appeared longer on the right anterior caudal oblique views than on the anteroposterior ( p < 0.0001, < 0.0001, < 0.0001) or right anterior oblique ( p < 0.0001, = 0.001, < 0.0001) views. The angle between the right portal trunk and the transverse portion of the left portal vein was wider on the right anterior oblique views than on the anteroposterior ( p < 0.0001) or right anterior caudal oblique ( p = 0.007) views. The angle between the right anterior and posterior portal branches was wider on the right anterior caudal oblique views than on the anteroposterior ( p < 0.0001) or right anterior oblique ( p = 0.030) views. The right anterior caudal oblique projection provides the best image of the proximal portal vein, and therefore should be obtained whenever possible in preoperative staging of hepatobiliary cancer.
本研究的目的是确定经皮肝门静脉造影的哪种投照方式能最佳显示门静脉近端的解剖结构。对通过前后位、右前斜位和右前尾状斜位投照获得的47例门静脉造影图像进行回顾性分析。测量不同投照方式下右门静脉主干、左门静脉横部、右前和右后门静脉分支的长度，以及右门静脉主干与左门静脉横部之间、右前和右后门静脉分支之间的夹角。采用方差分析和谢费法评估差异。左门静脉横部以及右前和右后门静脉分支在右前尾状斜位视图上比在前后位（p < 0.0001，< 0.0001，< 0.0001）或右前斜位（p < 0.0001，= 0.001，< 0.0001）视图上显得更长。右门静脉主干与左门静脉横部之间的夹角在右前斜位视图上比在前后位（p < 0.0001）或右前尾状斜位（p = 0.007）视图上更宽。右前和右后门静脉分支之间的夹角在右前尾状斜位视图上比在前后位（p < 0.0001）或右前斜位（p = 0.030）视图上更宽。右前尾状斜位投照能提供门静脉近端的最佳图像，因此在肝胆癌术前分期时应尽可能采用该投照方式。
