基于计算流体力学的门静脉压力测定在原发性肝癌切除术前规划中的应用  

Application of portal vein pressure measurement based on computational fluid dynamics in preoperative planning of resection of hepatic carcinoma

作　　者：黄从云 彭淑牖 刘文瑛 朱剑华 吴黎明 谭勇 欧阳再兴 宋灏 Huang Congyu;Peng Shuyou;Liu Wenying;Zhu Jianhua;Wu Liming;Tan Yong;Ouyang Zaixing;Song Hao(Department of Hepatobiliary Surgery,Yuebei People’s Hospital Affiliated to Shantou University Medical College,Shaoguan 512025,China;Department of General Surgery,No.2 Affiliate Hospital,Zhejiang University Medical School,Hangzhou 310009,China)

机构地区：[1]汕头大学医学院附属粤北人民医院肝胆外科,韶关512025 [2]浙江大学附属第二医院普通外科,杭州310009

出　　处：《中华实验外科杂志》2023年第10期1955-1958,共4页Chinese Journal of Experimental Surgery

基　　金：广东省生物医学创新平台建设项目(2018-B9)。

摘　　要：目的探讨基于计算流体力学的门静脉压力(PVP)测定及其在原发性肝癌术前规划中的临床价值。方法收集2020年1月至2021年4月汕头大学医学院附属粤北人民医院16例肝癌患者,肝脏CT数据导入3D-Doctor 4.0软件重建肝脏(包括门静脉)3D模型,利用Ansys19.0软件模拟计算PVP,与手术或介入时测定的实际PVP比较,采用t检验比较PVP实际值与PVP模拟值,两者相关性分析采用Pearson检验;按照手术规划计算剩余肝体积;剩余肝体积(FLR)结合模拟PVP确定肝癌治疗方案。结果16例患者术前或介入前PVP模拟值为(22.2±9.2)cmH_(2)O,实际PVP为(20.9±8.4)cmH_(2)O,差异无统计学意义(t=0.419,P>0.05);PVP模拟值与PVP实际值呈正相关(r=0.965,P<0.01);结合剩余肝体积和模拟PVP,14例接受肝癌切除手术,2例接受末梢门静脉栓塞(TBPVE)联合经皮肝动脉化疗栓塞术(TACE)治疗。结论基于计算流体力学模拟的PVP水平反映实际PVP水平,结合剩余肝体积可指导肝癌治疗方式选择。Objective To explore the measurement of portal vein pressure(PVP)based on computational fluid dynamics(CFD)and its clinical value in the preoperative planning of resection of hepatic carcinoma.Methods From January 2020 to April 2021,CT data of 16 patients with hepatocellular carcinoma were imported into 3d-doctor 4.0 software to reconstruct the liver 3D model(including portal vein)at Yuebei people’s Hospital Affiliated to Medical College of Shantou University:(1)PVP was simulated by ANSYS 19.0 software,and compared with the actual PVP measured during the operation or the intervention.Pearson correlation was used to analyze the correlation between the actual PVP and the simulated PVP;(2)The future liver remnant(FLR)was calculated according to the preoperative surgical planning;(3)The FLR combined with the simulated PVP was used to determine the selection of treatment for hepatocellular carcinoma.Continuous variables were compared using Student’s t-test,Pearson test was used for correlation analysis.Results There was no significant difference between the simulated PVP and the actual PVP[(22.2±9.2)cmH_(2)O vs.(20.9±8.4)cmH_(2)O,t=0.419,P>0.05].The simulated PVP was positively correlated with the actual PVP(r=0.965,P<0.01).Based on the simulated PVP combined with the FLR,14 patients underwent hepatectomy,2 patients underwent the terminal portal vein embolization combined with TACE.Conclusion The PVP level based on CFD simulation reflects the actual PVP level,and combined with the FLR can guide the choice of hepatocellular carcinoma treatment.

关 键 词：肝切除 肝癌 剩余肝体积 门静脉压 计算流体力学 

分 类 号：R735.7[医药卫生—肿瘤]