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目的 探讨多排螺旋CT三维重建在肝脏外科中的应用价值。方法 2 0 0 2年 4月至 2 0 0 3年 10月对2 0例肝脏肿瘤病人术前行 16层螺旋CT增强扫描 ,并在CT工作站上应用多排螺旋CT表面容积重建及多平面容积重建软件行肝动脉、门静脉和肝静脉的三维影像重建 ,测量全肝体积、肝肿瘤体积及拟切部分肝脏体积 (包括肿瘤体积 ) ,观察病人术后血清谷丙转氨酶、总胆红素、血氨水平及腹水情况 ,计算病人残肝体积与标准肝体积之比。结果 2 0例病人经肝血管三维重建后均能从各个角度显示肝动脉、门静脉和肝静脉结构 (肝动脉可显示 2～3级分支 ,门静脉 3～ 4级分支 )、肝动脉变异情况、肿瘤与周围血管的关系。经三维重建后测得预切除肝脏体积平均为 4 78 75cm3 ,肿瘤体积平均为 374 6 5cm3 ,与手术切除标本所测体积基本符合 (P >0 0 5 )。残肝体积与标准肝体积之比小于 5 0 %时 ,病人术后肝功能重度损害的可能性增加。结论 多排螺旋CT三维重建技术能帮助术者在术前更直观地了解肝血管解剖关系、肿瘤与周围血管关系 ,对制定更完善的手术方案具有实用价值。多排螺旋CT三维重建可较准确测量肝体积 ,残肝体积与标准肝体积比值可帮助预测术后肝功能恢复情况。
Objective To investigate the value of multi-slice spiral CT three-dimensional reconstruction in liver surgery. Methods From April 2000 to October 2003, 20 patients with hepatic tumor underwent 16-slice spiral CT contrast-enhanced CT scan and CT scan with multi-slice spiral CT volume reconstruction and multi-plane volume Three-dimensional reconstruction of the hepatic artery, portal vein and hepatic vein was performed in reconstruction software. Whole liver volume, hepatic tumor volume and part of hepatic volume (including tumor volume) were measured. Serum alanine aminotransferase, total bilirubin and blood Ammonia levels and ascites, calculate the patient residual liver volume and standard liver volume ratio. Results All 20 patients showed hepatic artery, portal vein and hepatic vein structure (hepatic artery showing grade 2 to 3 branches and portal vein branches 3 to 4), hepatic artery variation, tumor Relationship with peripheral blood vessels. After three-dimensional reconstruction measured pre-resected liver volume average 4 78 75cm3, the average tumor volume 374 6 5cm3, and the volume measured by surgical resection specimens (P> 0 05). When the ratio of residual liver volume to standard liver volume is less than 50%, the possibility of severe postoperative liver function damage increases. Conclusion Multi-slice spiral CT three-dimensional reconstruction can help the surgeon to understand the relationship between hepatic vascular anatomy and the relationship between the tumor and the surrounding blood vessels more preoperatively, which is of practical value in developing a more complete surgical plan. Multi-slice spiral CT three-dimensional reconstruction can be more accurate measurement of liver volume, residual liver volume and standard liver volume ratio can help predict postoperative recovery of liver function.