基于Dong’s肝段分型体系的右半肝门静脉分析及临床意义  

AN ANALYSIS OF THE PORTAL VEIN IN THE RIGHT LOBE OF THE LIVER BASED ON DONG'S LIVER SEGMENTS CLASSIFICATION SYSTEM AND ITS CLINICAL SIGNIFICANCE

作　　者：高菲[1,2] 周显军 董蒨[1,2] 朱呈瞻 陈鑫[1] 张虹 段于河 聂佩[4] 罗文娟[5] 白玉作[6] GAO Fei;ZHOU Xianjun;DONG Qian;ZHU Chengzhan;CHEN Xin;ZHANG Hong;DUAN Yuhe;NIE Pei;LUO Wenjuan;BAI Yuzuo(Department of Pediatric Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院小儿外科,山东青岛266003 [2]山东省数字医学与计算机辅助手术重点实验室 [3]青岛大学附属医院肝胆外科 [4]青岛大学附属医院放射科 [5]浙江大学医学院附属儿童医院小儿外科 [6]中国医科大学附属盛京医院小儿外科

出　　处：《精准医学杂志》2018年第4期337-341,345,共6页Journal of Precision Medicine

基　　金："十二五"国家科技支撑计划课题(2013BAI01B-03);山东省重点研发计划(2016GGB14019);青岛市自主创新重大专项(14-6-1-6-zdzx);青岛市博士后面上项目(2016046)

摘　　要：目的应用海信计算机辅助手术系统(Hisense CAS)研究右半肝4级门静脉血管的解剖并测量各分支流域体积,指导精准肝切除术。方法应用Hisense CAS对810例符合纳入标准的不同年龄段人体肝脏上腹部增强CT扫描图像进行肝脏及血管三维重建,在Dong’s肝段分型体系基础上对右半肝4级门静脉血管进行进一步分析及体积测量。结果 Hisense CAS可以立体地显示肿瘤与肝内血管的位置关系,清晰显示4级门静脉血管走行并自动测量各肝段体积。810例中A型共355例(43.83%),其中右前支呈头尾侧支者193例(23.83%),右前支呈腹背侧支者162例(20.00%)。B型共250例(30.86%)。C型共71例(8.77%),分为C-a型、C-b型,C-a型51例(6.30%),其中右前支呈头尾侧支者30例(3.70%),右前支呈腹背侧支者21例(2.60%);C-b型20例(2.47%)。D型共134例(16.54%),其中右前支呈四分叉者14例(1.73%),右前支呈一支主干多分叉者13例(1.60%),右前支来自门静脉左干者92例(11.36%),6段来自右前支者15例(1.85%)。结论右半肝门静脉存在较多变异,各分支流域体积存在差异。通过对大样本量的右半肝4级门静脉血管进行三维重建并分析其走行及供应肝段体积,可更好地指导精准肝切除术。Objective To investigate the anatomy of grade 4 portal branches in the right lobe of the liver and measure liver volume of each branch using Hisense Computer-assisted Surgical System（CAS）,and to provide accurate guidance for hepatectomy. Methods Hisense CAS was used for three-dimensional reconstruction of the liver and blood vessels based on the upper abdominal contrast-enhanced computed tomography（CT）images of 810 patients of different ages who met the inclusion criteria.A further analysis and volume measurement were performed for grade 4 portal branches in the right lobe of the liver based on the Dong＇s liver segments classification system. Results Hisense CAS displayed the positional relationship between tumors and intrahepatic vessels,clearly showed grade 4 portal branches in the right lobe of the liver,and then automatically measured the volume of each hepatic segment.Of all 810 patients,355（43.83%）had type A,among whom 193（193/810,23.83%）had cranio-caudal type and 162（162/810,20.00%）had ventro-dorsal type;250 patients（30.86%）had type B;71 patients（8.77%）had type C,among whom 51（51/810,6.30%）had type C-a and 20（20/810,2.47%）had type C-b,and among the patients with type C-a,30（30/810,3.70%）had cranio-caudal type and 21（21/810,2.60%）had ventro-dorsal type;134 patients（16.54%）had type D,among whom 14（14/810,1.73%）had quadrifurcation of the right anterior portal vein,13（13/810,1.60%）had multiple bifurcations of the right anterior portal vein,92（92/810,11.36%）had the right anterior portal vein from the left trunk,and 15（15/810,1.85%）had 6 segments from the right anterior portal vein. Conclusion There are many variations in the portal vein in the right lobe of the liver and there is a significant difference in liver volume of each branch.The three-dimensional reconstruction and analysis of a large number of grade 4 portal branches in the right lobe of the liver can achieve a good understanding of the shape and liver volume of each branch and provide

关 键 词：门静脉 成像 三维 肝切除术 精准医学 外科手术 计算机辅助 

分 类 号：R322.47[医药卫生—人体解剖和组织胚胎学]