肝动脉解剖学的计算机3D影像研究及其在活体肝移植中的意义

Computer 3D imaging study of hepatic artery anatomy and its significance in living donor liver transplantation

目的采用计算机3D重建模型,研究肝动脉的解剖和肝脏第4段动脉的解剖,并讨论其在活体肝移植中的意义。方法采用该中心99例低位梗阻性黄疸病例的DICOM格式的薄层增强CT影像,以Intrasense Myrian®工作站进行肝脏、肝动脉、门静脉、胆管的3D模型重建,并对肝动脉和A4进行描述性解剖学研究。结果99例均成功完成肝脏、肝动脉、门静脉和胆管的3D重建。按照改良的Hiatt分型,肝动脉的解剖类型1型79例(79.8%),2型14例(14.1%),3型3例(3.0%),4型2例(2.0%),5型1例(1.0%)。Couinaud分段第4段动脉参考Jin等的分型分为3型,1型38例(38.4%),2型52例(52.5%),3型9例(9.1%)。结论肝动脉及A4均存在各种变异形式,对活体肝移植具有重要影响。计算机3D重建是评估肝脏脉管解剖的良好工具。术前利用计算机3D重建进行个体化解剖学评估有利于手术设计和手术安全。

Objective To study the anatomy of hepatic artery and the artery of Couinaud segment 4 by using computer three-dimensional(3D)reconstruction model,and discuss its significance in living donor liver transplantation.Methods Ninety-nine cases of low obstructive jaundice in our center were performed with thin-slice enhanced computed tomography(CT)images in DICOM format.The 3D models of liver,hepatic artery,portal vein and bile duct were reconstructed by Intrasense Myrian®workstation,and the descriptive anatomy of hepatic artery and A4 was studied.Results The 3D reconstruction of liver,hepatic artery,portal vein and bile duct was completed in all the 99 cases.According to the modified Hiatt classification,there were 79 cases(79.8%)of hepatic artery anatomy type 1,14 cases(14.1%)of type 2,3 cases(3.0%)of type 3,2 cases(2.0%)of type 4 and 1 case(1.0%)of type 5.According to Jin′s classification,the artery of Couinaud segment 4 was divided into 3 types:38 cases(38.4%)of type 1,52 cases(52.5%)of type 2,and 9 cases(9.1%)of type 3.Conclusion There are various anatomical variations in hepatic artery and A4,which has important influence on living donor liver transplantation.Computer 3D reconstruction is a good tool to evaluate the anatomy of hepatic vessels.Preoperative computer 3D reconstruction for individualized anatomical evaluation is beneficial to surgical design and the patient′s safety.