管道铸型标本断层摄影法对肝门静脉的三维重建

Three-dimensional reconstruction of hepatic portal vein by laminagraphy of cast specimens

背景:以往的影像诊断中,主要观察二维图像,随着医学科技的发展及诊疗设备的不断更新,在三维空间里研究人体内小血管的分布,已成为今后解剖学研究的必然。目的:利用管道铸型标本断层摄影法对肝门静脉系统进行三维重建,为腹腔镜肝切除手术提供可靠的解剖学依据。设计、时间及地点:以成人新鲜尸体为观察对象,CT扫描计算机三维重建实验,于2007-10/2008-03在海南医学院解剖实验室和海南医学院附属医院CT室完成。对象:非肝胆疾病死亡成人新鲜标本10例,患者及家属自愿捐献。方法:预处理标本,经肝门静脉注入氧化铅与明胶混悬液,用美国QE Lights Speed VCT64层CT连续扫描,利用CT自带软件进行三维重建,表面成像法显示其外部形态,透明成像法显示其内部管道系统。主要观察指标:门静脉的各级分支的出现以及管壁清晰度、饱满度。结果:横断面原始图像及其三维图像重建均达到满意的效果,可清晰显示5级以上门静脉分支,重建后的模型可以任意三维旋转。结论:管道铸型标本断层摄影法是肝门静脉系进行三维重建的一种有效技术方法,对腹腔镜肝外科术前计划制定和术中操作具有临床意义。

BACKGROUND： Two dimensional images are observed in previous imaging diagnosis. With the development of medical technology and treatment equipment, the distribution of small vessels on the human body in the three-dimensional space has become necessary. OBJECTIVE： To explore three-dimensional reconstruction of hepatic portal vein by laminagraphy of cast specimens to provide anatomic basis for hepatectomy. DESIGN, TIME AND SETTING： Observation of fresh adult cadaver; computer three-dimensional reconstruction through CT scanning. The experiment was performed at the Department of Anatomy, Hainan Medical College and Department of CT, Hospital of Hainan Medical College between October 2007 and March 2008. MATERIALS： Ten specimens of liver from voluntary adult cadavers without hepatic disease. METHODS： The liver specimens were perfused with lead oxide-gelatin mixture through hepatic portal vein, and scanned consecutively with CT （QE Lights Speed VCT 64, USA）. Three-dimensional reconstruction of hepatic portal vein was made by CT with the CT-data. The outside appearance was shown using surface imaging method, and inner tract system was displayed using transpaxent imaging. MAIN OUTCOME MEASURES： Occurrence of branches of hepatic portal vein; clearness and satiation of the vessel wall. RESULTS： Cross-sectional images and three-dimensional reconstruction images were all satisfied. Three-dimensional reconstruction models could show the fifth grade branch of portal vein clearly while hepatic portal vein was blurry, and the models could rotate in every direction. CONCLUSION： Laminagraphy of the cast specimens is an effective means for three-dimensional reconstruction of hepatic portal vein, which is clinically significant for preoperative protocol and perioperative procedure.