基于三维可视化技术的脾门区脾动脉三维分型

Three-dimensional classification of splenic artery in splenic hilum based on 3D visualization

目的探讨基于三维可视化技术(3DVT)的脾门区脾动脉(SA)三维分型。方法本研究对象为2018年6月至2021年6月在安徽医科大学第一附属医院及皖南医学院附属弋矶山医院诊治的100例患者CT检查影像学资料。患者均签署知情同意书,符合医学伦理学规定。其中男61例,女39例;年龄49~88岁,中位年龄63岁。所有患者行薄层增强CT扫描,提取数据导入三维可视化系统进行三维重建。观察SA分支数目、分布范围、立体走行,与胰尾末端及脾门的空间位置关系,进行三维可视化分型。结果100例脾门区SA、脾脏、胰腺三维模型重建成功率均为100%(100/100)。SA一级分支数目为1支者4例(4%),2支76例(76%),3支15例(15%),多支(≥4支)5例(5%)。SA总分支点与脾门的距离为0~68 mm,中位数为19 mm。SA总分支点与胰尾末端的距离为0~127 mm,中位数为16 mm。脾门与胰尾的距离为0~138 mm,中位数为21 mm。SA分为5型:A型4例(4%),B型76例(76%),C型16例(16%),D型2例(2%),E型2例(2%)。结论脾门区解剖结构复杂多变,术前采用3DVT可对SA末端分支观察和个体化分型,该分型对临床实施精准个体化脾脏和胰腺手术具有一定指导意义。

Objective To investigate the three-dimensional classification of splenic artery(SA)in splenic hilum based on three-dimensional visualization(3DVT).Methods CT scan data of 100 patients admitted to the First Affiliated Hospital of Anhui Medical University and Yijishan Hospital Affiliated to Wannan Medical College from June,2018 to June,2021 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,61 patients were male and 39 female,aged from 49 to 88 years,with a median age of 63 years.All patients received thin-slice enhanced CT scan,and the data were extracted and imported into the 3D visualization system for 3D reconstruction.The number,distribution range,three-dimensional direction of SA branches,and the spatial relationship with the end of pancreatic tail and splenic hilum were observed and 3D classification were performed.Results The success rate of 3D model reconstruction of SA in the splenic hilum,spleen and pancreas in 100 patients was 100%(100/100).Regarding the number of primary SA branches,4 patients(4%)had 1 branch,2 branches in 76 cases(76%),3 branches in 15 cases(15%)and multiple branches(≥4)in 5 cases(5%),respectively.The distance between the primary branching of SA and splenic hilum was 0-68 mm,with a median of 19 mm.The distance between the primary branching of SA and the end of pancreatic tail was 0-127 mm,with a median of 16 mm.The distance between splenic hilum and pancreatic tail was 0-138 mm,with a median of 21 mm.SA could be divided into 5 types:type A in 4 cases(4%),type B in 76 cases(76%),type C in 16 cases(16%),type D in 2 cases(2%)and type E in 2 cases(2%),respectively.Conclusions The anatomical structure of splenic hilum is complex and varied.Preoperatively,3DVT can be applied to observe and classify the terminal branches of SA,which can provide guidance for precise and individualized splenic,pancreatic surgeries.