虚拟肝脏技术测量82例肝段体积的研究

Application of virtual liver technique in measurement of 82 cases of hepatic segments volume

目的应用虚拟肝脏技术重建正常肝脏及肝段三维图像，测量各肝段体积，为肝脏外科手术提供指导。方法16排螺旋CT扫描采集二维图像数据，应用自主开发的虚拟肝脏手术规划软件Liv1．0重建82例正常肝脏及各肝段三维图像，全方位显示肝脏及内部管道的图像信息，自动测量各肝段体积。结果重建肝脏形态逼真，解剖标志清楚，肝内门静脉、肝静脉清晰显示，肝段内门静脉分支、肝静脉属支走行及相互关系明晰，肝段在肝脏表面分布如地图状，段间分界呈不规则波浪状。肝脏总体积为（1242±232）cm^3、Ⅰ段体积（20±7）cm^3、Ⅱ段（153±49）cm^3、Ⅲ段（129±36）cm^3、Ⅳ段（160±46）cm^3、Ⅴ段（209±50）cm^3、Ⅵ段（142±49）cm^3、Ⅶ段（173±58）cm^3、Ⅷ段（256±73）cm^3，分别占全肝体积的百分比为（1．6±0．6）％、（12．3±3．5）％、（10．4±3．0）％、（14．2±3．7）％、（16．3±4．2）％、（12．0±3．6）％、（13．9±4．4）％、（20．5±6．3）％。左半肝（Ⅱ、Ⅲ、Ⅳ段）体积为（445±96）cm^3，占全肝体积的百分比（35．8±6．8）％，右半肝（Ⅴ、Ⅵ、Ⅶ、Ⅷ段）体积为（796±135）cm^3，占全肝体积的百分比（64．1±12．0）％。结论虚拟肝脏手术规划软件Liv1．0重建肝脏及肝段图像清晰逼真，测得肝段体积具体数据，对活体肝移植、肝段为本的肝切除术具有一定的指导意义。

Objective To reconstruct the three-dimensional images of liver, hepatic segments by virual liver technique, and measure volumes to provide reference for liver surgery. Methods Based on the two-dimensional image data collected by the 16-slice helical CT scanning,three-dimensional visualized models of 82 cases of normal liver and hepatic segments were reconstructed, the image information of liver and interior vessel was showed thoroughly, and hepatic segments volumes were measured automatically with the virtual liver surgery planning software Livl. 0. Results The mode had high fidelity and its anatomical landmarks were clear. The branches of intrahepatic portal veins, hepatic venous system and their relationship could be displayed distinctly. The boundaries between the hepatic segments were not straight. The mean total liver volume was （ 1242 ± 232 ） cm^3 and hepatic segments volumes were ： segment Ⅰ （20 ± 7） cm^3 , segment Ⅱ （153 ±49） cm^3 ,segment Ⅲ （129 ±36） cm^3 ,segment Ⅳ （160 ±46） cm^3 ,segment Ⅴ （209 ±50） cm^3 ,segment Ⅵ （ 142 ± 49） cm^3, segment Ⅶ （ 173 ± 58 ） cm^3, and segment Ⅷ （256 ± 73 ） cm^3, respectively. The percentages of segment [ to segment Ⅷ were （ 1.6 ± 0.6 ） %, （ 12.3 ± 3.5 ） % , （ 10.4 ± 3.0 ） % , （ 14.2 ± 3.7）% ,（16.3 ±4.2）% ,（12.0 ±3.6）% ,（13.9±4.4）% ,and （20.5 ±6.3）% respectively. The left liver （ segments Ⅱ, m and Ⅳ ） volume was （445 ± 96 ） cm^3, and the right liver （ segments Ⅴ, Ⅵ, Ⅶ, and Ⅷ ） （796± 135 ） cm^3. Conclusion The three-dimensional images of liver and hepatic segments can be well reconstructed by the virtual liver surgery planning software Livl. 0. The data of hepatic segments volumes can provide reference for the living donor liver transplantation and segment-oriented liver surgery.