基于CT影像人工气腹对肝脏形态及腹部血流影响的研究  

Morphological changes of liver in patients with postoperative intestinal adhesion under artificial pneumoperitoneum CT

作　　者：柳牧青 陈晓霞 滑蓉蓉 杜思晗 何绪成 王贵生 LIU Muqing;CHEN Xiaoxia;HUA Rongrong;DU Sihan;HE Xucheng;WANG Guisheng(Graduate School of Jinzhou Medical University,Jinzhou,Liaoning Province 121001,China;Department of Diagnostic Radiology,the Third Medical Center,Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]锦州医科大学研究生院,辽宁锦州121001 [2]中国人民解放军总医院第三医学中心放射诊断科,北京100039

出　　处：《实用放射学杂志》2023年第12期1967-1970,1979,共5页Journal of Practical Radiology

基　　金：国家重点研发计划项目(2022YFB4702602);北京市自然科学基金项目(7222319);首都特色临床应用研究项目(Z211100002921047)。

摘　　要：目的基于CT影像研究人工气腹条件下肝脏形变和腹部血管内径改变特点及肠粘连对其的影响。方法回顾性选取行腹部CT平扫和人工气腹CT的患者61例,不符合纳入标准8例,其中存在术后肠粘连(POIA)41例,无POIA 12例。采用三维后处理软件分别对患者平扫和气腹状态下CT影像中的气体体积、肝脏体积、肝脏表面积的大小以及腹主动脉、下腔静脉、门静脉的内径进行描绘测算。对比分析人工气腹前后,所有患者测量指标的改变,并对比是否合并肠粘连对上述指标的影响。结果到达同等压力的气腹状态下,有无POIA患者腹腔内气体体积差异无显著意义(P=0.753)。在非气腹CT平扫状态下,POIA患者的肝脏体积显著高于无POIA患者(P<0.01)。给予人工气腹压力后,所有患者的肝脏体积与肝脏表面积均较气腹前减小,而POIA组变化更为显著(P=0.003,P=0.002)。给予人工气腹压力后,所有患者下腔静脉3个位置以及门静脉位置1的血管内径减小(P<0.05),而POIA组下腔静脉位置1和门静脉位置1的内径减小更为显著(P=0.022,P=0.038)。其余血管内径变化及组间比较未见显著差异。结论人工气腹状态会使肝脏体积、表面积及部分腹部血管内径减小,为患者尤其是POIA患者腹腔镜下腹部手术术中导航和实时校正提供了科学依据。Objective To investigate the characteristics of liver deformation and changes in abdominal vascular diameter under artificial pneumoperitoneum based on CT images,and also to reveal the impact of intestinal adhesion on these characteristics.Methods A retrospective study was conducted on 61 patients who underwent abdominal CT scan and artificial pneumoperitoneum CT.Eight cases did not meet the inclusion criteria.The sample included 41 patients with postoperative intestinal adhesion(POIA)and 12 patients without POIA.A three-dimensional post-processing software was used to quantify the gas volume,liver volume,liver surface area,and lumen of the abdominal aorta,inferior vena cava,and portal vein on CT images of patients who underwent abdominal CT scan and artificial pneumoperitoneum CT.The measured indices were compared before and after artificial pneumoperitoneum in all patients,and the impact of intestinal adhesion on the aforementioned indices was evaluated.Results At equivalent levels of pneumoperitoneum pressure,no statistically significant difference was observed in the quantity of gas in the abdominal cavity between patients with and without POIA(P=0.753).In the absence of pneumoperitoneum,POIA patients exhibited a significantly higher liver volume than non-adhesion patients(P<0.01).Following the application of artificial pneumoperitoneum pressure,both liver volume and liver surface area were reduced in all patients,with a more pronounced decrease in POIA group(P=0.003,P=0.002).In addition,the reductions in the internal diameters of the inferior vena cava at three locations and the portal vein position 1 were also observed in all patients(P<0.05).Notably,the POIA group exhibited more significant decrease in the internal diameters of inferior vena cava position 1 and the portal vein position 1(P=0.022,P=0.038).No significant differences were observed in the changes of internal diameter of other blood vessels or in the intergroup comparison.Conclusion Artificial pneumoperitoneum can reduce the volum,the surface a

关 键 词：人工气腹 肝脏形态 腹部血管 术后肠粘连 

分 类 号：R459.9[医药卫生—治疗学] R322.47[医药卫生—临床医学] R323.3