刘　浏，潘　轲

·肝发育不良·

CT和MRI对肝右叶发育不良的诊断价值探讨

刘浏，潘轲

目的探讨电子计算机断层扫描（CT）和磁共振成像（MRI）对肝右叶发育不良的诊断价值。方法选取24例在本院行CT和MRI扫描的肝右叶发育不良患者，结合文献资料综合分析患者肝脏CT和MRI影像学检查特点。结果本组肝右叶发育不良患者24例，男性8例，女性16例;年龄在40～85岁，平均年龄为（60.7±3.2）岁；采用MRI检查发现者6例，采用CT检查发现者18例，两种检查方法诊断者4例；影像学检查表现为肝右叶体积缩小，门静脉及其分支出现细小或者缺如。肝左叶增大18例，肝左叶正常6例。尾状叶体积缩小，伴有尾叶内发生胆汁淤积3例，尾状叶体积增大者15例。14例出现肝外胆管结石，12例胆囊右后旋，8例患者行胆囊切除。24例患者均出现了肝内胆管扩张，12例出现脾脏增大，9例伴发肝脏肿瘤，并发腹膜转移1例。结论CT和MRI检查对于诊断肝右叶发育不良具有重要的临床意义。

肝右叶发育不良；体层摄影术，X线计算机；磁共振成像;诊断

【Abstract】ObjectiveTo investigate the application of computed tomography（CT）and magnetic resonance imaging（MRI）in diagnosis of agenesis of right hepatic lobe.MethodTwenty-four patients with agenesis of right hepatic lobe were recruited in our hospital，and they were all checked-up by CT and MRI.ResultsOur series included eight men，and sixteen women，with the average age of（60.7±3.2）yr-old；the agenesis of right hepatic lobe were diagnosed by MRI in 6，by CT in 18，and by both in 4；the imaging showed shrunk volume of right lobe，narrow portal vein and even lost its branches；left hepatic lobe enlarged in 18，and with normal left hepatic lobe in 6；hepatic caudate lobe shrank in 3，and enlarged in 15；extrahepatic bile duct stone in 14，dislocation of gall bladder in 12；all patients had cholangiectasis，12 had splenomegaly，and 9 had neoplasm. ConclusionThe application of CT and MR imaging for the diagnosis of right lobe dysplasia have important clinical significance.

【Key words】Agenesis of the right hepatic lobe；Computed tomography；Magnetic resonance；Diagnosis

作为一类异常罕有的先天性疾病，肝右叶发育不良在已有的文献报道中均以少数个案出现，突出的症状是眼黄和皮肤黄染，肝脾无肿大，右上腹部压痛明显和莫非氏征阳性等[1，2]。肝右叶发育不良一般男性比女性多见，但本组报道的患者中，则是以女性较多，男性8例，女性16例。根据相关的报道，约有三分之一的患者年龄在70以上，诊断较晚[3]。本研究探讨了CT和MRI对肝右叶发育不良的诊断价值，现报道如下。

1　资料与方法

1.1临床资料自2012年3月～2014年9月我科