右下肺静脉及其属支分布与汇合模式分型的多层螺旋CT影像解剖学研究

doi:10.3760/cma.j.issn.2095-7041.2019.02.010

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摘要目的探讨右下肺静脉(RLL)属支的多层螺旋CT血管造影(MSCTA)影像解剖学分布特征、汇合模式分型及其临床应用价值。方法采用回顾性横断面研究方法。自2017年3月—2018年7月泰山医学院附属医院行MSCTA检查的病例中,筛选肺静脉及属支显示优良者100例,其中男54例、女46例,年龄24～86(58.9±13.54)岁。将MSCTA原始图像传到后处理工作站,进行容积再现(VR)和多平面重组(MPR),观察右下肺静脉属支数目、分布特征及汇合方式,进而对其进行命名和分型。结果右下肺静脉整体汇合方式分型有RLLⅠ型(2支型)、RLLⅡ型(3支型)、RLLⅢ型(4支型),分别占67%(67/100)、28%(28/100)、5%(5/100)。RLLⅠ型最常见,有2种汇合方式、5种分型;RLLⅡ型最复杂,有6种汇合方式、7种分型;RLLⅢ型最少见,有4种汇合方式、4种分型。少见的静脉引流模式中,异位中叶静脉(异位V4、异位V4+V5)和异位上叶静脉(异位V2)分别占7%(7/100)和4%(4/100)。上段静脉分为单干型和双干型,分别占88%(88/100)、12%(12/100)。内侧底段静脉(V7)为最细小的底段静脉,其汇入处无规律,共统计了10种汇入情况。前段静脉(V8)、外侧底段静脉(V9)、后底段静脉(V110)有二分支型、三分支型和四分支型3种型式,分别占95%(95/100)、4%(4/100)和1%(1/100)。结论右下肺静脉属支引流及汇合模式复杂多变;手术前MSCTA可清晰显示肺静脉属支的分布规律,从而提高胸腔镜下解剖性肺段切除术的安全性。

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	王晓妮
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	刘林祥

关键词 ：肺静脉, 分型, 变异, 体层摄影术,X线计算机, 血管造影, 电视胸腔镜手术

Abstract：Objective To investigate the anatomical distribution and confluence pattern classification of the right inferior pulmonary vein branch by multi-slice spiral CT angiography (MSCTA) images, and to discuss the related of clinical value application.Methods Retrospective cross-sectional study. The imaging data of 100 healthy adults who underwent MSCTA examination in the Affiliated Hospital of Taishan Medical University from March 2017 to July 2018 were collected, including 54 males and 46 females with age of 24-86 (58.9±13.54) years. The original data of images were transmitted to the post-processing station for volume rendering (VR) and multiplanar reformation (MPR). The number, distribution and confluence of the branches of right inferior pulmonary vein were observed on the MSCTA images , then were named and typed.Results The whole convergence patterns of the right lower pulmonary veins include RLL typeⅠ (2 stems), RLL typeⅡ (3 stems), RLL type Ⅲ (4 stems), accounting for 67%(67/100), 28%(28/100) and 5%(5/100) respectively. TypeⅠ was the most common pattern, with 2 ways of confluence patterns and 5 subtypes, whereas TypeⅡ was the most complex pattern , with 6 ways of confluence patterns and 7 subtypes. TypeⅢ was rare, with 4 ways of confluence patterns and 4 subtypes. However, there were some other rare variations: the ectopic middle lobe vein (ectopic V4, ectopic V4+V5) and the ectopic superior pulmonary vein (ectopic V2), accounting for 7%(7/100) and 4%(4/100), respectively. Moreover, superior segmental vein(V6) was divided into single-stem type and two-stem type, accounting for 88%(88/100) and 12%(12/100) respectively. Mediobasal segmental vein(V7) was the smallest basal vein, the confluence patterns of which were irregular, and a total of 10 patterns were counted. Ventrobasal, laterobasal, and dorsobasal segmental veints(V8, V9, V10) had bifurcation, trifurcation and quadrifurcation types, accounting for 95%(95/100), 4%(4/100) and 1%(1/100) respectively.Conclusions The drainage and confluence patterns of the right inferior pulmonary veins are complex and variable.The distribution of pulmonary vein branches can be clearly showed by MSCTA before operation, which will improve the safety of thoracoscopic anatomical pulmonary segmentectomy.

Key words： Pulmonary veins Classification Variation Tomography X-ray computer Angiography Video-assisted thoracic surgery

收稿日期: 2018-11-06

通讯作者: 刘林祥, Email: lxliu@tsmc.edu.cn

引用本文:

王晓妮,王晨辰,李祥彤,张正峰,刘林祥. 右下肺静脉及其属支分布与汇合模式分型的多层螺旋CT影像解剖学研究[J]. 中华解剖与临床杂志, 2019, 24(2): 138-144.
Wang Xiaoni, Wang Chenchen, Li Xiangtong, Zhang Zhengfeng, Liu Linxiang. Anatomical study of the distribution and confluence patterns of the right inferior pulmonary vein and its branches by multi-slice spiral CT imaging. Chinese Journal of Anatomy and Clinics, 2019, 24(2): 138-144.

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