256层智能CT肝容积和门脉三维重建对Glisson鞘横断法肝切除的指导作用  

Three-dimensional CT angiography for preoperative evaluation of patients undergoing hepatic resection using the Glissonean pedicle transection method

作　　者：唐继红[1] 付必莽[1] 朱洪[1] 唐波[2] 孙勇[2] 张捷[1] 杨达宽[1] 何晓顺[3] 

机构地区：[1]昆明医学院第二附属医院肝胆胰外科一病区云南省肝胆外科研究所,云南省昆明市650101 [2]昆明医学院第二附属医院医学影像科,云南省昆明市650101 [3]中山大学附属第一医院器官移植中心,广东省广州市510080

出　　处：《世界华人消化杂志》2010年第32期3420-3424,共5页World Chinese Journal of Digestology

摘　　要：目的:研究智能CT(iCT)肝脏三维重建对Glis-son鞘横断肝切除的指导作用.方法:23例肝癌患者术前行Philips256层iCT肝脏三期扫描,并以iCT自带软件对肝容积和门脉行三维重建,根据门脉类型和容积重建结果建立模拟解剖性肝切除模型.临床用模拟模型指导临床Glisson鞘横断法肝切除并评价该模型对临床肝切除的指导作用.结果:23例重建肝脏容积为1311mL±323mL,肝质量为1102g±271g.针对Glisson横断法肝切除可将门脉分为规则型(Ⅰ)、左中右型(Ⅱ)、左右型(Ⅲ)和特殊型(Ⅳ).Ⅰ和Ⅱ型患者适合Glisson鞘横断肝切除,而Ⅲ型和Ⅳ型宜需解剖Glisson鞘后阻断肝血流.模拟切除肝模型和实际切除肝之间的肝质量无统计学差异(P>0.05).结论:以256层iCT3D肝脏重建指导Glisson鞘横断肝切除不但可准确了解肝内门脉的走形和分支类型,找到最佳Glisson鞘的阻断位置,而且可以精确评估切除肝的容积,保证了肝切除的精准性和安全性.AIM：To investigate the use of three-dimensional CT angiography for preoperative evaluation of patients undergoing hepatic resection using the Glissonean pedicle transection method.METHODS：The image data for 23 patients undergoing CT angiography with a Philips 256-slice Intelligent CT Scanner were analyzed with Philips brilliance software.Three-dimensional and maximum intensity projection（MIP）image reconstruction was performed.Based on the reconstructed data,liver segment resection models were developed to evaluate the possibility of preoperative virtual liver segment resection.RESULTS：Based on three-dimensional reconstruction data,the average liver volume and weight,excluding the portal vein and hepatic vein,were 1 219 mL ± 191 mL and 1 451 g ± 227 g,respectively.The portal vein could be divided into four types：I,II,III and IV.Patients with types I and II portal vein were fit for hepatic resection using the Glissonean pedicle transection method.There is no significant difference in the weight of resected liver between virtual and actual hepatectomy（P 0.05）.CONCLUSION：Three-dimensional CT angiography is a good strategy for preoperative evaluation of patients undergoing hepatic resection using the Glissonean pedicle transection method.

关 键 词：256层智能CT 肝容积 门脉 三维重建 Glisson横断肝切除 

分 类 号：R657.3[医药卫生—外科学]