多排螺旋CT三维重建在肝脏外科中的应用

Application value of helical CT three-dimensional reconstruction techniques to liver surgery.

目的 探讨多排螺旋CT三维重建在肝脏外科中的应用价值。方法 2 0 0 2年 4月至 2 0 0 3年 10月对2 0例肝脏肿瘤病人术前行 16层螺旋CT增强扫描 ,并在CT工作站上应用多排螺旋CT表面容积重建及多平面容积重建软件行肝动脉、门静脉和肝静脉的三维影像重建 ,测量全肝体积、肝肿瘤体积及拟切部分肝脏体积 (包括肿瘤体积 ) ,观察病人术后血清谷丙转氨酶、总胆红素、血氨水平及腹水情况 ,计算病人残肝体积与标准肝体积之比。结果 2 0例病人经肝血管三维重建后均能从各个角度显示肝动脉、门静脉和肝静脉结构 (肝动脉可显示 2～3级分支 ,门静脉 3～ 4级分支 )、肝动脉变异情况、肿瘤与周围血管的关系。经三维重建后测得预切除肝脏体积平均为 4 78 75cm3 ,肿瘤体积平均为 374 6 5cm3 ,与手术切除标本所测体积基本符合 (P >0 0 5 )。残肝体积与标准肝体积之比小于 5 0 %时 ,病人术后肝功能重度损害的可能性增加。结论 多排螺旋CT三维重建技术能帮助术者在术前更直观地了解肝血管解剖关系、肿瘤与周围血管关系 ,对制定更完善的手术方案具有实用价值。多排螺旋CT三维重建可较准确测量肝体积 ,残肝体积与标准肝体积比值可帮助预测术后肝功能恢复情况。

Objective To evaluate the role of three-dimensional computed tomographic (3D-CT) reconstruction techniques in liver surgery. Methods From Apr 2002 to Oct 2003,20 patients with liver tumor underwent helical CT of the liver with 3D reconstruction. Then hepatic artery, portal vein and hepatic vein images were reconstructed and total liver volume, tumor volume and resected liver volume were measured with volume rendering(VR) and multiplanar volume reconstruction(MPVR). Levels of postoperative serum alanine aminotransferase,total bilirubin, ammonia and ascites were measured. Furthermore, the ratio of remnant liver volume(RLV) to standard liver volume(SLV) was calculated. Results 3D-CT cculd render anatomic detail of hepatic vascular structure from varied point of view in 3D images from helical computed tomographic scans.The relation of the liver tumor to the intrahepatic vascular trees also could be displayed clearly.The volumes of tumor and resected liver measured by 3D-CT were similar to actual volumes(P>0.05).When the ratio of RLV to SLV were less than 50%,the postoperative liver injury showed a trend toward more severity. Conclusion By providing an accurate 3D map of the liver and its vasculature, 3D-CT reconstructions are a useful adjunct for surgical planning. 3D-CT can also measure liver volume accurately,and the ratio of RLV to SLV can partly predict postoperative liver function status.