三维可视化技术在胰腺占位患者胰周血管解剖变异分析中的应用  

Application of three-dimensional visualization technique in anatomical variation of peripancreatic vessels in patients with pancreatic occupancy

作　　者：潘璇 王小明[1] 奚士航 王成[2] 张超[3] 侯辉[4] 鲁正[5] 于江涛[6] Pan Xuan;Wang Xiaoming;Xi Shihang;Wang Cheng;Zhang Chao;Hou Hui;Lu Zheng;Yu Jiangtao(Department of Hepatobiliary Surgery,Yijishan Hospital of Wannan Medical College,Wuhu 241001,China;Department of Biliopancreatic Surgery,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Hepatobiliary Surgery,Fuyang People's Hospital,Fuyang 236000,China)

机构地区：[1]皖南医学院弋矶山医院肝胆外科,芜湖241001 [2]中国科学技术大学附属第一医院胆胰外科,合肥230001 [3]安徽医科大学第一附属医院肝胆外科,合肥230022 [4]安徽医科大学第二附属医院肝胆外科,合肥230601 [5]蚌埠医学院第一附属医院肝胆外科,蚌埠233004 [6]阜阳市人民医院肝胆外科,阜阳236000

出　　处：《中华肝胆外科杂志》2022年第3期206-209,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：安徽省中央引导地方科技发展专项资金项目(YDZX20183400004899);皖南医学院弋矶山医院科技创新团队"攀峰"项目(KPF2019011);皖南医学院弋矶山医院科研能力"高峰"-塔尖项目(KGF2019T03)。

摘　　要：目的探讨三维可视化技术在胰腺占位患者胰周血管解剖变异分析中的应用价值。方法回顾性分析2018年6月至2019年12月在皖南医学院弋矶山医院、中国科学技术大学附属第一医院、安徽医科大学第一附属医院、安徽医科大学第二附属医院、蚌埠医学院第一附属医院、阜阳市人民医院诊断为胰腺占位并完成上腹部增强CT扫描的98例患者资料。最终入组94例患者,其中男性56例,女性38例,年龄(61.2±7.2)岁。通过三维可视化技术重建腹部脏器及血管,分析胰周血管解剖变异,包括腹腔干、肝动脉系统、门静脉系统、胰背动脉。结果腹腔干血管三维重建率为100.0%(94/94)。60例异常腹腔干分别为:肝脾干型5例(5.3%)、胃脾干型1例(1.1%)、肝胃脾肠系膜干型3例(3.2%)、肝胃脾肝左干型17例(18.1%),腹腔干发出1支或多支膈下动脉34例(36.2%)。肝动脉系统MichelsⅠ型69例(73.4%)、Ⅲ型2例(2.1%)、Ⅴ型1例(1.1%)、Ⅷ型2例(2.1%)、Ⅸ型1例(1.1%),不属于Michels分型的包含腹腔干发出副肝左动脉17例(18.1%),副肝左动脉由胃左动脉发出合并肝左动脉由肠系膜上动脉发出1例(1.1%),副肝右动脉由腹腔干发出合并肝固有动脉发出肝右前动脉联合胃十二指肠动脉发出肝右后动脉1例(1.1%)。异常走行胰背动脉3例。38例(40.4%)肠系膜下静脉汇入肠系膜上静脉,4例(4.3%)肠系膜下静脉汇入脾静脉和肠系膜上静脉连接处。结论三维可视化技术有助于确定胰周血管变异情况,对胰腺占位患者术前精准评估及指导手术具有一定意义。Objective To explore the application value of three-dimensional visualization technology in the analysis of anatomic variation of peripancreatic vessels in patients with pancreatic space occupation.Methods A total of 98 cases in Yijishan Hospital of Wannan Medical College,the First Affiliated Hospital of University of Science and Technology of China,the First Affiliated Hospital of Anhui Medical University,the Second Affiliated Hospital of Anhui Medical University,the First Affiliated Hospital of Bengbu Medical College,Fuyang People's Hospital from June 2018 to December 2019 were retrospectively analyzed.Of 94 patients were enrolled,including 56 males and 38 females,aged(61.2±7.2)years.Abdominal organs and blood vessels were reconstructed by 3D visualization technology,and anatomic variation of peripancreatic vessels was analyzed,including abdominal trunk,hepatic artery system,portal vein system and dorsal pancreatic artery.Results The three-dimensional reconstruction rate of celiac trunk vessels was 100.0%(94/94).The 60 cases of abnormal celiac trunk were as follows:liver and spleen trunk in 5 cases(5.3%),stomach and spleen trunk in 1 case(1.1%),liver,stomach and spleen mesentery trunk in 3 cases(3.2%),liver,stomach and spleen mesentery trunk in 17 cases(18.1%),celiac trunk with one or more inferior phrenic arteries in 34 cases(36.2%).There were 69 cases(73.4%)of Michels typeⅠ,2 cases(2.1%)of Michels typeⅢ,1 case(1.1%)of MichelsⅤ,2 cases(2.1%)ofⅧ,and 1 case(1.1%)of typeⅨof hepatic artery system.There were 17 cases(18.1%)of accessory left hepatic artery from celiac trunk which did not belong to Michels classification.Left accessory hepatic artery originated from left gastric artery and left hepatic artery originated from superior mesenteric artery in 1 case(1.1%),right accessory hepatic artery originated from celiac trunk combined with proper hepatic artery and right anterior hepatic artery combined with gastroduodenal artery originated from right posterior hepatic artery in 1 case(1.1%).Abnormal walki

关 键 词：成像 三维 解剖变异 胰周血管 

分 类 号：R735.9[医药卫生—肿瘤]