【摘要】：目的應(yīng)用海信計(jì)算機(jī)輔助手術(shù)系統(tǒng)(海信CAS)對不同年齡組人群(新生兒至成年人)進(jìn)行肝臟及血管三維重建,建立人類數(shù)字肝臟數(shù)據(jù)庫,對肝內(nèi)血管變異及肝臟體積進(jìn)行分析統(tǒng)計(jì),尋找肝臟解剖學(xué)變異規(guī)律。方法本院及外院搜集正常肝臟上腹部增強(qiáng)CT數(shù)據(jù)664例,記錄年齡、性別、肝臟體積,并行三維重建。將其中106例兒童上腹部增強(qiáng)CT進(jìn)行肝臟及血管三維重建,分析小兒肝臟門靜脈解剖變異并進(jìn)行分型,按照年齡分組,自動測量右前葉、右后葉及左葉的流域體積。結(jié)果海信CAS能夠快速準(zhǔn)確測量肝臟體積,立體、清晰的顯示小兒肝臟門靜脈主干的解剖走形,并自動測量各流域體積。門靜脈分型:a型82例(77.36%),b型12例(11.32%),c型8例(7.55%),d型2例(1.89%),e型1例(0.94%),f型1例(0.94%)。根據(jù)門靜脈右前支、右后支及左支供血區(qū)域?qū)崿F(xiàn)個體化肝段劃分。各年齡段組間肝臟體積差異有統(tǒng)計(jì)學(xué)意義(P0.05)。肝臟總體積與年齡、身高、體重、體表面積均呈正相關(guān)(年齡:R=0.889,P0.05;身高:R=0.914,P0.05;體重:R=0.919,P0.05;體表面積:R=0.931,P0.05)。結(jié)論肝臟總體積隨年齡、身高、體重、體表面積變化而變化,小兒肝臟門靜脈解剖變異復(fù)雜多樣。海信CAS能準(zhǔn)確立體的顯示出肝內(nèi)血管走形并自動測量流域體積,為小兒門靜脈分型及個體化肝段劃分提供可靠依據(jù),對小兒精準(zhǔn)肝切除術(shù)的實(shí)施具有重要意義。目的獲取肝間葉性錯構(gòu)瘤患兒影像學(xué)檢查數(shù)據(jù),使用海信計(jì)算機(jī)輔助手術(shù)系統(tǒng)(Hisense CAS)數(shù)字化重建出可視化立體患肝模型,探討計(jì)算機(jī)輔助手術(shù)系統(tǒng)在小兒巨大肝間葉性錯構(gòu)瘤(HMH)診斷治療中的價值。方法自2010年9月至2015年10月,我院收治5例HMH患兒,術(shù)前均行上腹部增強(qiáng)CT檢查,3例(2013年7月至2015年10月)應(yīng)用海信CAS對患兒CT資料行三維重建及模擬肝切除,制定手術(shù)計(jì)劃,術(shù)中實(shí)施精準(zhǔn)肝切除術(shù)。結(jié)果2例(2010年9月至2013年5月)根據(jù)術(shù)前CT檢查分別實(shí)施肝右葉切除術(shù)及肝左葉切除術(shù)。3例(2013年7月至2015年10月)應(yīng)用海信CAS系統(tǒng)成功進(jìn)行肝臟及腫瘤的三維重建,并進(jìn)行模擬肝切除,根據(jù)術(shù)前制定的手術(shù)計(jì)劃分別成功實(shí)施:肝Ⅱ、Ⅲ、Ⅴ、Ⅷ部分及IV全部切除術(shù),肝Ⅴ段切除術(shù),右半肝切除術(shù)。術(shù)后恢復(fù)好,病理檢查證實(shí)為HMH。隨訪3月~5年未見并發(fā)癥及復(fù)發(fā)。結(jié)論HMH影像學(xué)檢查與肝囊腫相似,易誤診。海信CAS能清晰、直觀顯示HMH的位置、形態(tài)及其與肝內(nèi)管道系統(tǒng)的關(guān)系,其術(shù)前規(guī)劃功能利于術(shù)者制定最佳手術(shù)方案,實(shí)施個體化精準(zhǔn)肝臟腫瘤切除。
[Abstract]:Objective to establish a human digital liver database by using Hisense computer aided surgery system (Hisense CAS) to reconstruct the liver and blood vessels in different age groups (from newborn to adult). The variation of hepatic vessels and the volume of liver were analyzed and analyzed to find out the regularity of hepatic anatomical variation. Methods six hundred and sixty-four patients with normal liver and abdomen enhanced CT were collected. Age, sex, liver volume and three-dimensional reconstruction were recorded. Three-dimensional reconstruction of liver and blood vessels was performed with enhanced CT in children's upper abdomen. The anatomical variation of hepatic portal vein in children was analyzed and classified. The watershed volumes of right anterior lobe, right posterior lobe and Zuo Ye were measured automatically according to age. Results Hisense CAS can quickly and accurately measure the liver volume, stereoscopic, clearly display the anatomy of the portal vein trunk of the liver in children, and automatically measure the volume of each watershed. There were 82 cases of type a (77.36%), 12 cases of type b (11.32%), 8 cases of type c (7.55%), 2 cases of type d (1.89%), 1 case of type e (0.94%) and 1 case of type f (0.94%). According to the right anterior branch, right posterior branch and left branch of portal vein, the individual hepatic segments were divided. There was significant difference in liver volume among different age groups (P0.05). The total liver volume was positively correlated with age, height, weight and body surface area (age: r = 0.889, P 0.05; height: r = 0.914, P 0.05; body weight: r = 0.919, P 0.05; body surface area: r = 0.931, P 0.05). Conclusion the total volume of liver varies with age, height, body weight and body surface area. The anatomic variation of hepatic portal vein in children is complicated and varied. Hisense CAS can accurately display the intrahepatic vessel shape and automatically measure the watershed volume, which provides a reliable basis for the classification of the portal vein and individual hepatic segments in children. It is of great significance for the implementation of accurate hepatectomy in children. Objective to obtain the imaging data of children with hepatic mesenchymal hamartoma, and to reconstruct the visual stereoscopic liver model using Hisense computer aided surgery system (Hisense CAS). To evaluate the value of computer-assisted surgery system in the diagnosis and treatment of giant hepatic stromal hamartoma (HMH) in children. Methods from September 2010 to October 2015, 5 patients with HMH were treated in our hospital. All patients underwent enhanced CT examination in upper abdomen before operation. Three patients (from July 2013 to October 2015) underwent three-dimensional reconstruction and simulated hepatectomy of CT data with Hisense CAS. The operative plan was made and the precise hepatectomy was performed during the operation. Results from September 2010 to May 2013, right lobectomy and Zuo Ye's resection of liver were performed in 2 cases (from September 2010 to May 2013), respectively. Three cases (July 2013 to October 2015) underwent three-dimensional reconstruction of liver and tumor with Hisense CAS system. The simulated hepatectomy was performed successfully according to the preoperative operation plan: total resection of liver 鈪，

本文編號：2438647