256层智能CT精准肝切除模型的建立及临床应用

RECONSTRUCTION OF MIMETIC ACCURATE HEPATECTOMY MODEL WITH 256 SLICE INTELLIGENT CT FOR HEPATIC RESECTION

目的通过philips256层智能CT(iCT)对肝脏三维重建(3D)并行模拟解剖性肝切除,研究肝切除术前最佳的影像支持方案。方法提取103例256层iCT的肝脏三期图像,用Philips Brilliance Workspace Portal软件对肝脏及门脉属支行MIP和3D重建,并建立模拟肝段切除模型,评估其对解剖性肝切除的指导作用。结果 103例3D肝脏容积为(1219±191)ml,肝质量为(1451±227)g。34例(33.0%)具典型的肝段门静脉干(三级支主干),而其余69例(67.0%)无肝段门静脉主干,此时肝段门脉为2～4(2.5±1.1)支、直接发自门脉二级或三级分支。以具有三级门脉独立供血的锥形单位为一个肝段,则肝脏段的数量为:6段28例(27.2%),7段34例(33.0%),8段41例(39.8%),平均(7.1±0.8)段。模拟切除肝和实际切除肝之间的肝质量无统计学差异(P>0.05)。结论并非每个Couinand肝段都具有肝段门脉干,解剖性肝切除时如果把其中一支当成主支结扎势必造成阻断不彻底、导致出血过多;术前256层:3D重建和模拟肝段切除是指导精准解剖性肝切除的理想手段。

Objective Studying the reconstruction of iCT three dimensional reconstruction（3D）and accurate hepatectomy model in order to guide liver segment hepatectomy.Methods 103 patients′iCT photographs of arterial phase,portal phase and venae cavae phase,taken with scanned with philips 256 slice intelligent CT and analyzed with Philips brilliance software were used and three dimension（3D）and maximum intensity projection（MIP）pictures were reconstructed.Based on the cone-shaped unit that have independent third canals（arteries,vein and biliary tract）,then the liver segments resectionlie models were built to evaluate the possibility of the relative liver segments resection.Results For 3D reconstruction,the average volume and quality,except the portal vein and hepatic vein,were（1219±191）ml,and（1451±227）g,respectively.Among 103 cases,only 34（33.0%） patients′each liver segments had one independent portal vein,while the remained 69（67.0%） patients had 2～3 aequalis branches of portal vein which came from the second or third portal branches.Therefore,the liver segments were variable from 6 to 8（7.1±0.8）segments from person to person,and except for the caudate lobe,39.8%（41 cases）had 8 segments,33.0%（34 cases）had 7 segments and 27.2%（28 cases）had 6 segments.Weight of resected liver between imitating hepatectomy and practice hepatectomy was not different（P〉0.05）.Conclusion The number of independent liver segments is variable from person to person.With ligature of the portal veins which run into liver segments within operation,more bleeding would be occurred if operator only treat one portal vein while hepatectomy.But iCT 3D reconstruction and accurate mimesis surgical operate before operation offer a ideal way to avoid these problems.