数字化虚拟解剖学技术在经颈静脉肝内门腔静脉分流术和直接性门腔分流术中的应用  

Application of digitized virtual anatomical techniques in transjugular intrahepatic portosystemic stent shunt and direct intrahepatic portacaval shunt

作　　者：王剑华[1] 周庭永[2] 张本斯[1] 吕发金[3] 许俊峰[4] 唐艳隆[4] 张秀君[1] 

机构地区：[1]大理学院解剖学教研室,大理671000 [2]重庆医科大学解剖学教研室,,重庆400016 [3]重庆医科大学第一附属医院放射科,重庆400016 [4]大理学院附属医院放射科,大理671000

出　　处：《解剖学杂志》2011年第3期366-369,共4页Chinese Journal of Anatomy

摘　　要：目的：利用影像数字化虚拟解剖学技术，经颈静脉肝内门腔静脉分流术（TIPSS）、直接性门腔静脉分流术（DIPS）模拟穿刺途径与水平垂线间角度进行测量，以期为临床TIPSS、DIPS术提供解剖学资料。方法：选取上腹部64-MSCT扫描正常组共40例，肝硬化组16例。用智能追踪技术启动扫描，并将所得数据在GEADW4．2工作站进行处理。结果：正常组与肝硬化Child-PughA、B分级组TIPSS模拟穿刺途径与垂线间角度，除肝中静脉3cm与肝右静脉1cm问增大外，其余均呈减小趋势；DIPS术中下等分线模拟穿刺途径与垂线角度大于上等分线相应穿刺途径角度。门静脉左支1cm至上等分线的模拟穿刺途径与垂线角度在正常组与肝硬化Child—PughA、B分级组间差异有统计学意义。结论：影像数字化虚拟解剖学技术有助于提供活体功能状态下TIPSS、DIPS相关解剖学资料。可根据模拟途径与水平垂线间角度在体外调整穿刺套针的曲度。To validate feasibility of digitized virtual anatomical techniques applied in transjugular intrahepatic protosystemic stent shunt （TIPSS） and direct intrahepatic protacaval shunt （DIPS）. Methods： Based on the smart tracking technology （Smart Prep）, 64-MSCT scan of the upper abdomens of 40 individuals without liver diseases and 16 patients suf- fered from cirrhosis were performed. The data were analyzed using GE ADW4. 2 workstation. Results： In groups of normal and cirrhosis graded as Child-Pugh A and B, the angles between the vertical line and simulated puncture line of TIPSS were decreased, excluding those performed at 3 cm apart from the middle hepatic vein and 1 cm apart from the right hepatic vein. As to DIPS, the angles between the vertical line and simulated puncture line through the lower bisecting line were greater than those corresponding angles that performed through the upper bisecting line. Statistical difference was found in the angles between vertical line and the simulated puncture line from the point that 1 cm apart from the left branch of portal hepatic vein to the upper bisecting line in cases with liver diseases and patients suffered from cirrhosis graded as Child-Pugh A and B. Conclusion： Digitized virtual anatomic technology is an effective way to provide morphological data for TIPS and DIPS in vivo. The curvature of the puncture trocar should be adjusted in vitro according to the angles between the vertical line and simulated puncture line.

关 键 词：数字化 虚拟 经颈静脉肝内门腔静脉分流术 直接性门腔分流术 

分 类 号：R657.34[医药卫生—外科学]