256层智能CT肝门脉三维重建及分型对Glisson鞘横断肝切除的指导

摘要

Purpose To study the anatomic types of intrahepatic portal veinsusing 256 slice Intelligent CT Angiography and to provide a roadmap for hepatic resection.Materials and Methods Based on three-phase liver imaging in 163 patients using Philips 256 Slice Intelligent CT scanner and Philips Brilliance Workspace Portal software,three-dimensional (3D) reconstruction of liver volume and portal vein was performed. The portal veins were classified according to the requirement of Glissonean pedicle transection method for hepatic resection. Results Portal veins could be classified into 4 types: regular (type Ⅰ, 41.7％); left-middle-right (type Ⅱ, 47.3％) withsimilarleft, middle and right branches; left-right (typeⅢ, 9.8％) showing equal left and right branches and special (typeⅣ, 1.2％). The diameters of main portal vein among the four types showed no statistical difference (P＞0.05). Diameters of the first class branches in type Ⅱ portal veinswere not statistically different (P＞0.05); while in type Ⅰ, the right branch of the first class branches was significantly bigger than the left branch (P＜0.05), but the diameter of right anterior hepatic lobe and left main portal vein showed no statistical difference (P＞0.05). The volume of the left, middle and right hepatic lobes in each type accounted for about 1/3 of total liver volume. Conclusion Glissonean pedicle transection method for hepatic resection is preferred in about 89％ of patients with types Ⅰ and Ⅱ portal veins. For 11％ of patients, the risk of vascular injuries is high.%目的 采用256层智能CT(intelligent CT,ict)研究肝内门脉的解剖类型,为临床解剖性肝切除提供最佳的影像支持.资料与方法 提取163例PhilipsⅡ 256层iCT的肝三期图像,用Philips Brilliance Workspace Portal软件对肝门脉和体积行三维重建,并基于Glisson鞘横断法肝切除的需要进行分型.结果 门脉可分为规则型(Ⅰ型)、左中右型(Ⅱ型)、左右型(Ⅲ型)和特殊型(Ⅳ型).其中规则型和左中右型分别占41.7%和47.3%,适于行Glisson鞘横断肝切除;而左右型和特殊型分别占9.8%和1.2%,不适于该术式.各型间门脉主干管径差异无统计学意义(P＞0.05),左中右型中各一级分支主干间管径差异无统计学意义(P＞0.05);规则型中右主干管径明显大于左支和右前叶支(P＜0.05),但右前叶支与左主干管径差异无统计学意义(P＞0.05).各型间肝左、中、右叶体积均约占整肝体积的1/3.结论 89%的个体在三维影像支持下宜首选Glisson鞘横断肝切除,而11%的个体采用此法时容易误扎、损伤或漏扎临近属支.