腹腔血管和胰腺三维图像在胃癌术前规划和术中指导的初步探讨

Preliminary study on preoperative planning and intraoperative guidance in the light of three dimensional imaging of abdominal vessels and pancreas in gastric cancer

目的探索基于CT数据的腹腔血管和胰腺三维图像在胃癌术前规划和术中指导的可行性。方法选取2016-03~2016-11该院的4例胃癌患者进行64排螺旋CT多期扫描,采集CT数据,应用自行研发的liver CAD软件,对腹腔干及其分支进行自动抽出和三维重建,对胰腺的CT数据、门静脉及其分支的CT数据进行手工分割和三维重建,形成以胰腺为中心的腹腔干及其分支、门静脉及其分支的三维图像。以获得的三维图像为基础,对胃癌手术进行术前规划和术中指导。结果 4例患者均完成以胰腺为中心的腹腔干及其分支、门静脉及其分支的三维图像。4例患者的三维图像中,发生血管解剖变异1例,即胃左静脉直接汇入门静脉。以获得的三维图像为基础,4例患者均顺利进行了胃癌根治术的术前规划和术中指导。4例患者的手术均顺利完成,手术时间为260~330 min,术中出血量为50~400 ml,术后住院时间为7~12 d,无术中大出血、血管误扎等并发症发生。结论以胰腺为中心,胰腺、腹腔干及其分支、门静脉及其分支的三维图像,可以帮助外科医师术前了解腹腔干及其分支、门静脉及其分支的解剖情况,并指导术中胃癌淋巴结的清扫。

Objective To explore the feasibility of preoperative planning and intraoperative guidance in the light of pancreas and stomach vascular 3D image based on computed tomography（CT） data. Methods From March 2016 to November 2016, 4 patients with gastric cancer were scanned by 64 slice spiral CT. The CT data were collect- ed, and the celiac trunk and its branches were reconstructed to three dimensional image automatically by self-devel- oped liver CAD software. The CT data of pancreas and portal vein with its branches were segmented and reconstructed to three dimensional image manually. Then, it was set up that the three dimensional image of celiac trunk with its branches and the portal vein with its branches and the pancreas which was located in the center. The preoperative plannings and intraoperative guidances for gastric cancer surgery were performed based on the three dimensional im- age. Results The 4 patients were successfully reconstructed the three dimensional image of celiac trunk with its branches and the portal vein with its branches and the pancreas which was located in the center. Vascular anatomical variations were found in one case from these images, in which the termination of the left gastric vein was joined direct- ly in portal vein. The preoperative plannings and intraoperative guidances for gastric cancer radical surgery were per- formed successfully based on the three dimensional image in all the patients. 4 cases of them were operated on suc- cessfully with no intraoperative massive haemorrhage and other complications such as ligating blood vessels by mis- take. The operation time was 260 - 330 minutes, and the intraoperative blood loss was 50 - 400 ml. The postopera-tive hospitalization time was 7 - 12 days. Conclusion The three dimensional image of celiac trunk with its branches and the portal vein with its branches and the pancreas which is located in the center, can help the surgeons under- stand the anatomical condition of celiac trunk with its branches and the portal vein with its branches, and guide the surgeons to clear the lymph nodes during the operation.