小儿门静脉分型及肝脏体积测量的数字化研究

目的 应用海信计算机辅助手术系统(海信CAS)研究小儿门静脉解剖变异并测量相应的流域体积,为实施小儿精准肝切除术提供理论依据.方法 应用海信CAS将106例儿童上腹部增强CT进行肝脏及血管三维重建,分析小儿肝脏门静脉主干解剖变异并进行分型,按照年龄分组,自动测量右前叶、右后叶及左叶的流域体积.结果 海信CAS能够立体、清晰地显示小儿肝脏门静脉主干的解剖走行,并自动测量各流域体积.门静脉分型:a型82例(77.4％),b型12例(11.3％),c型8例(7.6％),d型2例(1.9％),e型1例(0.9％),f型1例(0.9％).根据门静脉右前支、右后支及左支供血区域实现个体化肝段划分.各年龄段组间肝脏体积差异有统计学意义(P＜0.05);肝脏总体积与年龄、身高、体重、体表面积均呈正相关(年龄:R=0.889,P＜0.05;身高:R=0.914,P＜0.05;体重:R=0.919,P＜0.05;体表面积:R=0.931,P＜0.05).结论 海信CAS能准确立体的显示出肝内血管走行并自动测量流域体积,为小儿门静脉分型及个体化肝段划分提供可靠依据,对小儿精准肝切除术的实施具有重要意义.

Digital research of classification of portal vein and measurement of liver volume for Children

Objective To classify portal vein and measure liver volume using Computer Assisted Surgical System (Hisense CAS) and provide theoretic rationales for individualized anatomical hepatectomy for children.Methods Thin-layer computed tomography (CT) imaging of 106 cases were reconstructed using Hisense CAS and typing of portal vein analyzed according to its direction and distribution.Anterior portal vein,posterior portal vein and left branch were labeled in different colors.Thus the margins of liver lobe and volume were displayed automatically.Results Hisense CAS could visualize portal vein and measure liver volume distinctly.Portal veins were classified into six types of a (82/106,77.4％),b (12/106,11.3％),c (8/106,7.6％),d (2/106,1.9％),e (1/ 106,0.9％) and f (1/106,0.9％).Individualized liver segment was divided into anterior portal vein,posterior portal vein and left branch of portal vein.Significant differences existed in liver volume (P＜ 0.05).There was a positive correlation between liver volume and age (R =0.889,P＜0.05),height (R=0.914,P＜0.05),body weight (R=0.919,P＜0.05) and body surface area (R=0.931,P＜ 0.05).Conclusions Variations are complex for pediatric portal veins.And liver volume changes with age,height,body weight and body surface area.Hisense CAS can clearly delineate the adjacent relationship of intrahepatic vascular and liver volume,provide reliable rationales for classifying portal vein and liver segment division and improve success rate of complex hepatectomy.