基于三维可视化技术的右半肝门静脉3D分型及分段

目的采用三维可视化技术研究右半肝门静脉系统的解剖，为计算机辅助个体化肝脏分段和解剖性肝切除提供形态学依
据。方法运用腹部医学图像三维可视化软件MI-3DVS对83例肝脏CT数据的肝静脉和门静脉分割重建，对门静脉右支的数
量、走向和分布规律进行三维观察、测量和统计分析，建立门静脉右支的3D分型，并以此为依据进行个体化肝脏分段。结果重
建后的门静脉模型可显示门静脉4级分支，门静脉右支三级分支基本分为P5、P6、P7、P8四大分支，根据其三级分支的三维分布，
将P5、P6、P7、P8 分为以下3D分型。P5 可分为5 型，A型有16 例（19.3%），B型有5 例（6%），C型有30 例（36.1%），D型有7 例
（8.5%），E型有25 例（30.1%）。P8 可分为4 型,A 型有29 例（34.9%），B型有29 例（34.9%），C型有10 例（12.1%），D型有15 例
（18.1%）。P6可分为4型，A型有35例（42.2%），B型有12例（14.5%），C型有33例（39.7%），D型有3例（3.6%）。P7可分为6型，
A型有27例（32.5%），B型有11例（13.3%），C型有27例（32.5%），D型有4例（4.8%），E型有12例（14.5%），F型有2例（2.4%）。以
门静脉三级分支供血区域实现了个体化肝段划分。结论右半肝门静脉三级分支解剖结构复杂多变，熟悉正常人群右半肝门静
脉3D分型，术前采用三维可视化技术对其解剖结构进行观察和个体化分段，对解剖性肝切除术的顺利实施具有指导意义。

Three-dimensional classification of the right portal vein and liver segmentation based on three-dimensional visualization technology

Objective To investigate the anatomy of right portal vein based on three-dimensional (3D) visualization technology
and provide a morphological basis for computer-assisted individualized liver segmentation and anatomical hepatectomy.
Methods Liver CT data of 83 cases were segmented and reconstructed using the medical image three-dimensional
visualization system (MI-3DVS), and 3D classifications of the right portal vein were established according to its branch
number, direction and distribution. Individualized liver segmentation was performed based on the 3D typing results. Results
The reconstructed portal vein models were capable of visualizing the fourth-order portal branches. Generally, the third-order
right portal branches were classified into P5, P6, P7 and P8 branches. According to the 3D distribution of the branches, P5
branches were classified into types A, B, C, D, and E [in 16 (19.3%), 5 (6%), 30 (36.1%), 7(8.5%), and 25 (30.1%) cases,
respectively], P8 branches into types A, B, C, and D [in 29 (34.9%), 29 (34.9%), 10 (12.1%), and 15 (18.1%) cases, respectively], P6
branches into types A, B, C, and D [in 35 (42.2%), 12 (14.5%), 33 (39.7%), and 3 (3.6%) cases, respectively], and P7 branches into
types A, B, C, D, E, and F [in 27 (32.5% ), 11(33.3% ), 27 (32.5% ), 4(4.8% ), 12 (14.5% ), and 2 (2.4% ) cases, respectively].
Individualized liver segmentation was achieved based on liver segments supplied by the third-order portal branches.
Conclusion 3D classifications of the complex and highly variant anatomy of third-order right portal vein and individualized
liver segmentation based on this classification before the operation facilitates successful performance of anatomical
hepatectomy.