个体化肝静脉、门静脉三维重建在肝切除术中的应用  

Three-dimensional reconstruction of individual hepatic veins and portal veins system in hepatectomy

作　　者：方驰华[1] 张永祥[1] 范应方[1] 杨剑[1] 项楠[1] 曾宁[1] 

机构地区：[1]南方医科大学珠江医院肝胆外科,广州510282

出　　处：《中华外科杂志》2014年第1期45-49,共5页Chinese Journal of Surgery

基　　金：基金项目：国家高技术研究发展计划（863计划）资助项目（2006AA022346、2012AA021105）;国家自然科学基金资助项目（81170458）;广东省自然科学基金团队资助项目（6200171）;广东省重大科技专项计划资助项目（2叭2A03040¨0013）;广东省中科院全面战略协作项目（2010A090100032）;广东省科技计划资助项目（2011t1031800088、20118031800091）

摘　　要：目的研究医学图像三维可视化系统（MI-3DVS）重建个体化肝静脉、门静脉的成像特点及变异情况，并评估其对肝脏肿瘤手术的指导价值。方法分析2008年6月至2012年9月在MI-3DVS辅助下进行的81例肝切除术患者的手术资料，其中男性61例，女性20例，年龄12—81岁，中位年龄46岁。恶性肿瘤患者69例，良性肿瘤患者12例。结合三维模型中肝静脉、门静脉的分布及变异情况，运用可视化仿真手术系统进行仿真切割选择手术方式。结果81例重建模型中，10例（12．3％）患者出现粗大的肝右后下静脉，34例（41．9％）出现Ⅳ段肝静脉。64例门静脉主干在肝门处分为左支和右支；10例门静脉主干在肝门处呈三叉状；6例门静脉左支和右前支共干从主干分出，右后支单独从主干发出；1例门静脉左支水平段缺如。81例患者均在MI-3DVS辅助下行肝切除术，小块肝切除57例；大块肝切除24例（相对缩小的大块肝切除12例），恶性肿瘤患者手术均为R0切除。术后未见残肝缺血、淤血发生，术后患者均未出现肝功能衰竭。结论MI-3DVS在肝切除术中为最佳手术方式的选择提供了直观的依据，可以降低手术风险，防止术后肝衰竭的发生。Objective To study the imaging characteristics and variations of individual digitized hepatic vein and portal vein which were reconstructed by medical image three-dimensional visualization system （MI-3DVS）, assess the value of MI-3DVS assisted hepatectomy. Methods From June 2008 to September 2012, the clinical data of 81 patients who underwent hepatectomy with the assist of MI-3DVS were retrospectively reviewed. There were 61 male and 20 female patients, and their age were 12-81 years （ median 46 years）. The patients with malignant tumors were in 69 cases and with benign tumors in 12 cases. The characteristics and variations of individual digitized hepatic vein and portal vein were observed. Omnidirectional rotation of the three-dimensional （3D） model to observe the distribution of intrahepatic venous system as well as the relationship between the tumor and the veins. 3D models were then simulated resection by the Freeform modeling system. Results Of all the 81 3D models of the patients, greater posterior hepatic veins appeared in 10 （12. 3% ） cases, segment VI hepatic vein appeared in 34 （41.9%） cases. The portal vein was separted with the left branch and the right branch in the hilar in 64 cases, the portal trunk was divided into the left branch of portal vein, the right anterior portal branches, the fight posterior portal branches trifurcated in 10 cases, the branch of right anterior portal vein start from the left trunk and the branch of fight posterior portal vein start from the main trunk independently in 6 cases, there was 1 case, lack of left branch of portal vein. 81 patients underwent hepatectomy with the assist of MI-3DVS, minor hepatectomy in 57 cases, major hepatectomy in 24 cases （ comparatively-reduced major hepatectomy in 12 cases）. Roresection was achieved in all of the patients. Both the inflow and the outflowwere maintained in the residual liver after the completion of hepatectomy. Postoperative liver failure was observed in none of the patients. Conclusions MI-3DVS in l

关 键 词：肝切除术 成像 三维 计算机 模拟 

分 类 号：R735.7[医药卫生—肿瘤]