基于三维可视化技术的肝右静脉系统解剖研究  

Anatomical study of right hepatic vein system based on three-dimensional visualization

作　　者：张飞鸿 季顾惟 许正刚 孙东伟 范烨 谭忠明 武正山 陆峰[2] 王科 ZHANG Feihong;JI Guwei;XU Zhenggang;SUN Dongwei;FAN Ye;TAN Zhongming;WU Zhengshan;LU Feng;WANG Ke(Hepatobiliary Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Department of General Surgery,Binhai County People’s Hospital,Yancheng 224599,China)

机构地区：[1]南京医科大学第一附属医院肝胆中心,江苏南京210029 [2]滨海县人民医院普外科,江苏盐城224599

出　　处：《南京医科大学学报（自然科学版）》2022年第5期658-665,共8页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金青年科学基金项目(82102150);江苏省自然科学青年基金项目(BK20210968);江苏省科技厅社会发展面上项目(BE2020708)。

摘　　要：目的:基于三维可视化技术构建肝右静脉系统的解剖路径图用于指导手术规划。方法:回顾性分析南京医科大学第一附属医院2018年7月—2021年6月的上腹部增强CT资料,导入海信计算机辅助系统行三维重建,模拟肝右静脉(right hepatic vein,RHV)引导的解剖性肝切除,测量并记录肝体积、RHV及各段属支的分布情况、解剖变异等数据。结果:纳入336例正常肝脏受检者,中位年龄59岁。全肝体积为1255.65(1071.43~1450.078)m L,男性的全肝体积显著大于女性(P<0.05)。336例受检者的RHV直径与全肝体积呈正向弱相关(r=0.242,P<0.05)。44.6%的受检者发现1(1~2)根右后下静脉(inferior right hepatic vein,IRHV)。RHV的标准化直径与是否伴有IRHV之间呈极弱负相关(r=-0.109,P<0.05)。比较伴有IRHV的RHV和不伴有IRHV的RHV的直径,两组之间存在显著差异(P<0.05),分别为7.95(6.51~10.40)mm和9.33(7.37~11.23)mm。15.8%受检者以IRHV为主导,RHV较短小,无法在肝断面上全程显露。最终选取283例RHV解剖正常的受检者构建解剖路径图。6段属支(hepatic veins draining segmentⅥ,V6)、7段属支(hepatic veins draining segmentⅦ,V7)主要分布在右后叶肝切除断面全长的0.45(0.33~0.55)和0.78(0.71~0.84)处,V6的数目显著多于V7的数目(P<0.05);5段属支(hepatic veins draining segmentⅤ,V5)、8段属支(hepatic veins draining segmentⅧ,V8)主要分布在左三叶肝切除断面全长的0.41(0.32~0.50)和0.78(0.70~0.86)处,V5的数目显著多于V8的数目(P<0.05)。V6的直径显著大于V5的直径(P<0.05)。结论:三维可视化技术有助于构建肝右静脉系统解剖路径图,对指导精准解剖性肝切除具有重要意义。Objective:This study aims to develop a novel roadmap of right hepatic vein(RHV)tributaries for surgical planning based on three-dimensional(3D)visualization.Methods:3D simulated anatomical liver resection(ALR)of healthy participants who underwent contrast-enhanced computed tomography(CECT)of the upper abdomen from July 2018 to June 2021 in the First Affiliated Hospital of Nanjing Medical University were retrospectively reviewed.Liver volume,distributions of RHV and its tributaries,incidence of the inferior right hepatic vein(IRHV)were estimated.Results:Total 336 eligible participants were assessed,with a median age of 59(48~67)years.The total liver volume was 1255.65(1071.43~1450.078)m L,which was significantly larger in males than in females(P<0.05).The Person correlation analysis revealed a positive and weak correlation between the diameter of RHV and the liver volume(r=0.242,P<0.05).1(1~2)IRHV was detected in 44.6%of volunteers.A negative and poor correlation was noted between the standardized diameter of RHV and the incidence of IRHV(r=-0.109,P<0.05).The diameter of RHV without IRHV was significantly larger than that of RHV with IRHV(P<0.05),which were 7.95(6.51~10.40)mm and 9.33(7.37~11.23)mm,respectively.There were15.8%of the participants excluded,whose RHV was short and unable to be fully exposed on the transection plane.Virtual RHVoriented ALR of 283 participants with normal RHV was assessed to develop the roadmap of RHV tributaries.Hepatic veins draining segmentⅥ(V6)and segmentⅦ(V7)were concentrated at 0.45(0.33~0.55)and 0.78(0.71~0.84)of the transection plane in virtual right posterior sectionectomy respectively,where the number of V6 was significantly more than that of V7(P<0.05).Hepatic veins draining segmentⅤ(V5)and segmentⅧ(V8)were concentrated at 0.41(0.32~0.50)and 0.78(0.70~0.86)of that in simulated left trisectionectomy respectively,where the number of V5 was significantly more than that of V8(P<0.05).The diameter of V6 was significantly larger than that of V5(P<0.05).Conclusion:Virtual r

关 键 词：肝右静脉 右后下静脉 三维可视化 解剖性肝切除 

分 类 号：R657.3[医药卫生—外科学]