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目的探索基于CT数据的腹腔血管和胰腺三维图像在胃癌术前规划和术中指导的可行性。方法选取2016-03~2016-11该院的4例胃癌患者进行64排螺旋CT多期扫描,采集CT数据,应用自行研发的liver CAD软件,对腹腔干及其分支进行自动抽出和三维重建,对胰腺的CT数据、门静脉及其分支的CT数据进行手工分割和三维重建,形成以胰腺为中心的腹腔干及其分支、门静脉及其分支的三维图像。以获得的三维图像为基础,对胃癌手术进行术前规划和术中指导。结果 4例患者均完成以胰腺为中心的腹腔干及其分支、门静脉及其分支的三维图像。4例患者的三维图像中,发生血管解剖变异1例,即胃左静脉直接汇入门静脉。以获得的三维图像为基础,4例患者均顺利进行了胃癌根治术的术前规划和术中指导。4例患者的手术均顺利完成,手术时间为260~330 min,术中出血量为50~400 ml,术后住院时间为7~12 d,无术中大出血、血管误扎等并发症发生。结论以胰腺为中心,胰腺、腹腔干及其分支、门静脉及其分支的三维图像,可以帮助外科医师术前了解腹腔干及其分支、门静脉及其分支的解剖情况,并指导术中胃癌淋巴结的清扫。
Objective To explore the feasibility of preoperative planning and intraoperative guidance of three dimensional images of celiac vessels and pancreas based on CT data. Methods Four patients with gastric cancer in our hospital from March 2016 to 2016-11 were examined by multislice spiral CT (64-slice spiral CT). CT data were collected and the CAD and CAD software were used to automatically extract and reconstruct the celiac trunk and its branches. CT data of the pancreas, CT data of the portal vein and its branches were manually segmented and three-dimensionally reconstructed to form a three-dimensional image of the pancreas-centered celiac trunk and its branches, portal veins and their branches. Based on the three-dimensional images obtained, preoperative planning and intraoperative guidance were given to gastric cancer surgery. Results All the 4 patients completed the three-dimensional images of the celiac trunk, its branches, the portal vein and its branches. In the three-dimensional images of 4 patients, one case of vascular anatomical variation occurred, ie, the left gastric vein directly into the portal vein. Based on the three-dimensional images obtained, all 4 patients underwent radical preoperative planning and intraoperative guidance of radical gastrectomy. All 4 patients underwent surgery successfully. The operation time ranged from 260 to 330 minutes. The intraoperative blood loss was 50 to 400 ml. The postoperative hospital stay was from 7 to 12 days. There were no major intraoperative hemorrhage and vascular misadjustment. Conclusion The three-dimensional image of the pancreas, celiac trunk and its branches, portal vein and its branches, which is centered on the pancreas, can help the surgeon to understand the anatomy of the celiac trunk and its branches, portal vein and its branches before surgery and guide the operation of the lymph nodes Sweep.