Gattoni F, Baldini U, Pompili G, Pozzato C, Uslenghi C
Istituto di Scienze Radiologiche, Ospedale S. Paolo, Università di Milano.
Radiol Med. 1993 Apr;85(4):421-4.
This study was aimed at investigating the occurrence of hepatic artery variants, at comparing the diagnostic value of duplex Doppler US with that of angiography, and at correlating the results with the technical problems in portal hypertension surgery. All patients were studied with angiography, conventional and duplex Doppler US. In 162 patients with portal hypertension, 38 hepatic artery variants (23.4%) were observed and classified according to Michaels. The commonest variant recognized by angiography was right hepatic artery arising from superior mesenteric artery (type III according to Michaels). US demonstrated hepatic artery variants in 9/162 patients (5.5%). At surgery, variants were found in 3/162 subjects (1.8%) and caused surgical problems in 2 of them (1.2%) - i.e., right hepatic artery arising from superior mesenteric artery. Arteriography is still the best examination to depict hepatic artery variants, while duplex Doppler US demonstrates only a few types. Moreover, the number of variants detected by imaging techniques (23.4%) differs greatly from that observed at surgery (1.8%). Finally, hepatic artery variants are not correlated with surgical problems, nor can the latter be foreseen by imaging methods. US is useful but not essential to detect hepatic artery variants which are subsequently confirmed by angiography.
本研究旨在调查肝动脉变异的发生率，比较双功多普勒超声与血管造影的诊断价值，并将结果与门静脉高压手术中的技术问题相关联。所有患者均接受了血管造影、传统超声和双功多普勒超声检查。在162例门静脉高压患者中，观察到38例肝动脉变异（23.4%），并根据迈克尔斯分类法进行分类。血管造影识别出的最常见变异是肠系膜上动脉发出的右肝动脉（根据迈克尔斯分类为III型）。超声在162例患者中的9例（5.5%）显示有肝动脉变异。手术中，在162例患者中的3例（1.8%）发现有变异，其中2例（1.2%）出现手术问题，即肠系膜上动脉发出的右肝动脉。血管造影仍是描绘肝动脉变异的最佳检查方法，而双功多普勒超声仅能显示少数几种类型。此外，成像技术检测到的变异数量（23.4%）与手术中观察到的数量（1.8%）差异很大。最后，肝动脉变异与手术问题无关，也无法通过成像方法预见手术问题。超声对于检测肝动脉变异有用，但并非必不可少，后续需通过血管造影加以证实。
