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目的通过philips256层智能CT(iCT)对肝脏三维重建(3D)并行模拟解剖性肝切除,研究肝切除术前最佳的影像支持方案。方法提取103例256层iCT的肝脏三期图像,用Philips Brilliance Workspace Portal软件对肝脏及门脉属支行MIP和3D重建,并建立模拟肝段切除模型,评估其对解剖性肝切除的指导作用。结果 103例3D肝脏容积为(1219±191)ml,肝质量为(1451±227)g。34例(33.0%)具典型的肝段门静脉干(三级支主干),而其余69例(67.0%)无肝段门静脉主干,此时肝段门脉为2～4(2.5±1.1)支、直接发自门脉二级或三级分支。以具有三级门脉独立供血的锥形单位为一个肝段,则肝脏段的数量为:6段28例(27.2%),7段34例(33.0%),8段41例(39.8%),平均(7.1±0.8)段。模拟切除肝和实际切除肝之间的肝质量无统计学差异(P>0.05)。结论并非每个Couinand肝段都具有肝段门脉干,解剖性肝切除时如果把其中一支当成主支结扎势必造成阻断不彻底、导致出血过多;术前256层:3D重建和模拟肝段切除是指导精准解剖性肝切除的理想手段。
Objective To study the optimal image support protocol before hepatectomy by simulating the hepatic resection (3D) anatomical hepatectomy via philips256 layer intelligent CT (iCT). Methods A total of 103 three-dimensional images of liver in 256 patients with iCT were extracted. MIP and 3D reconstruction of the liver and portal vein branches were performed with Philips Brilliance Workspace Portal software. The hepatic resection model was established to evaluate the guiding effect on anatomical liver resection. Results 103 cases of 3D liver volume (1219 ± 191) ml, liver mass (1451 ± 227) g. 34 cases (33.0%) had the typical hepatic portal vein (the third branch), while the remaining 69 cases (67.0%) had no hepatic portal vein. The hepatic portal was 2-4 (2.5 ± 1.1) , Directly from the portal vein two or three branches. The number of liver segments was 28 (27.2%) in segment 6, 34 (33.0%) in segment 7, and 41 (39.8%) in segment 8, with a conical unit with independent portal vein supply as a hepatic segment. , The average (7.1 ± 0.8) section. There was no significant difference in the liver mass between the resected resected liver and the resected liver (P> 0.05). Conclusions Not every Couinand liver segment has a hepatic portal vein. If one of the Couinand liver resections is a ligation of the main branch, it is bound to cause incomplete blockage and lead to excessive bleeding. Preoperative 256 levels: 3D reconstruction and simulation Segmental hepatectomy is an ideal means of guiding accurate anatomical liver resection.