磁共振虚拟肝血管三维重建在肝切除术中的应用

目的 探讨应用MR图像建立肝血管三维模型和虚拟肝切除在肝切除手术方案中的价值.方法 采用23例肝肿瘤患者肝脏静脉期MR图像重建肝血管三维模型,以任意角度显示肝脏、肿瘤及肝静脉、门静脉系统.在保证余肝充分门静脉供血及静脉回流的前提下行虚拟肝切除,计算拟切除肝体积及余肝体积,据此制定肝肿瘤切除手术方案并实施手术.结果 23例肝三维模型均可详细显示肝肿瘤及其血管解剖关系,虚拟肝切除评估肿瘤均可被切除.15例患者接受常规肝切除术,8例因肝右下静脉、肝中静脉变异或剥离肝中静脉而改变手术方案.23例肝肿瘤被完整切除,1例发生胆瘘,无肝功能衰竭病例.结论 肝肿瘤与血管MRI三维重建模型及虚拟肝切除术可用于指导肝肿瘤切除方案,减少术后并发症的发生.

Application of 3D reconstruction of virtual liver and vascular with MRI in liver resection

Objective To study the value of 3D models reconstruction of liver neoplasms, vessels and virtual hepatectomy with MRI in liver resection. Methods 3D models of liver and vascular were reconstructed with venous phase MRI of liver in 23 patients with liver tumor. In these 3D models, liver, neoplasms, hepatic veins and portal veins were observed. Virtual liver resection were performed on the premise of the remnant liver with sufficient portal venous blood supply and venous drainage. Total quasi-removal liver volume, tumor volume, remnant liver volume were calculated. Resection plans of liver neoplasms were made, then operations were performed. Results The detail anatomic relationship of liver neoplasms and vessels were clearly displayed in liver 3D models. Preoperative evaluation of virtual hepatectomy showed that all liver neoplasms could be removed. Conventional liver neoplasms resections were performed in 15 patients. The operation plans of 8 patients were changed because of variation of lower right hepatic vein, middle hepatic vein and dissecting middle hepatic vein. All liver neoplasms were completely resected in 23 patients. Biliary fistula occurred in 1 patient after resection. No hepatic failure occurred Conclusion Reconstruction of 3D model of liver neoplasms, vessels and virtual hepatectomy with MRI could be used to guide liver neoplasms operation planning and reduce postoperative complications.