肝门静脉CT三维重建在腹腔镜肝脏外科的应用研究

Study of three dimensional reconstruction of portal vein and its application on laparoscopic surgery of liver

目的 :报道肝门静脉CT三维重建应用于腹腔镜肝脏外科并评价其价值。方法 :铸型标本 4例及拟进行腹腔镜肝脏肿瘤切除的患者 8例 ,用CT图像进行三维重建 ,评价其在腹腔镜肝脏外科的应用价值。结果 :①铸型标本螺旋CT三维重建图像清晰显示肝门静脉的最远分支 ,血管边缘清晰光滑 ,肝实质与肝门静脉的空间关系明确。②病例CT三维重建图像清晰显示门静脉 5级分支 ,肝静脉隐约显影 ,肿瘤内无门静脉分支血管 ,腹腔镜手术证实三维重建诊断 ,三维重建图像显示肿瘤空间位置及与周围血管关系 ,镜下所见与重建图像一致。结论 :螺旋CT三维重建效果好 ,在很大程度上弥补了腹腔镜手术的局限性 ,是腹腔镜肝脏外科术前的重要检查方法 ,在腹腔镜肝脏外科的应用具有良好的前景。

Objective: To evaluate the value of three dimensional reconstruction of portal vein in laparoscopic liver surgery. Methods: The value of three dimensional CT angiography were evaluated as a tool for laparoscopic surgery of liver in 4 liver cast specimens and 8 patients whose tumor in liver were going to be resected by laparoscopy. Results: ①On the three dimensional spiral CT angiography of the cast specimens, the farthest branch of the portal vein can be seen and its border was smooth and clear. The spatial relationship of portal vein and hepatic parenchyma was also clear. ②The three dimensional spiral CT angiography of patients can show the fifth grade branch of portal vein clearly while the hepatic vein was blurry. In this imaging, there was not branch of portal vein in the tumor. The laparoscopic operation confirmed the diagnosis of the three dimensional angiography. The three dimensional CT angiography of portal vein of patients showed the spatial position of tumor and its spatial relationship with the ambient vessel. Conclusions: The portal vein three dimensional CT angiography can provide very necessary materials for the laparoscopic operation in some degree. It is an important examination method before laparoscopic hepatectomy, which will be of much value in laparoscopic liver surgery in the future.