發(fā)布時(shí)間：2018-05-03 01:23

  本文選題：腹部成像 + 肝外傷��； 參考：《南方醫(yī)科大學(xué)》2015年碩士論文

【摘要】：研究背景：傳統(tǒng)肝臟分段法基于形態(tài)解剖學(xué),依據(jù)肝臟外觀分段,在膈肌表面,鐮狀韌帶將肝臟分為解剖上的左、右兩葉,這很不同于功能上的左、右葉或者說(shuō)左、右半肝。在傳統(tǒng)分段法中方葉屬于肝右葉,而功能屬于左葉的一部分。傳統(tǒng)分段方法不顯示內(nèi)部血管和膽管結(jié)構(gòu),該方法優(yōu)點(diǎn)是比較直觀,但不實(shí)用。1957年Couinaud C以Glisson系統(tǒng)在肝內(nèi)分布為基礎(chǔ)提出Couinaud分段法,將肝臟分為左右半肝,五葉和八段,并逐漸在亞洲和歐洲普及。該分段方法以肝裂和門靜脈及肝靜脈在肝內(nèi)分布為基礎(chǔ),依據(jù)功能解剖學(xué)將肝臟分為8個(gè)獨(dú)立段。肝右靜脈將肝臟分為右前段和右后段,肝中靜脈將肝臟分為左半葉和右半葉(或者說(shuō)左半肝和右半肝)此面從下腔靜脈到膽囊窩通過(guò),肝左靜脈將肝左葉分為內(nèi)側(cè)段和外側(cè)段。門靜脈將肝臟分為上、下段,左、右門靜脈發(fā)出上、下分支分別進(jìn)入每段的中心,尾狀葉既是一個(gè)葉也是一個(gè)段。每個(gè)肝段分別用羅馬數(shù)字Ⅰ-Ⅷ標(biāo)記,Ⅰ段：尾狀葉；Ⅱ段：左外葉上段；Ⅲ段：左外葉下段；Ⅳ段：左內(nèi)葉(Bismuth分段法第4段又分為4a和4b段)；V段：右前葉下段；Ⅵ段：右后葉下段；Ⅶ段：右后葉上段；Ⅷ段：右前葉上段,段的編號(hào)依據(jù)順時(shí)針進(jìn)行,Couinaud分段法按順時(shí)針?lè)较驅(qū)⒏鞫尉幪?hào),其優(yōu)點(diǎn)是每段都是一個(gè)獨(dú)立單位,切除任何一段而不會(huì)影響其他。為保證肝臟存活,切除時(shí)必須沿著這些分段周圍的血管進(jìn)行,即切除線平行于肝靜脈,這樣位于中心位置的門靜脈、膽管和肝動(dòng)脈得以保留。該分段方法實(shí)用性強(qiáng),每個(gè)肝段有獨(dú)立的流入和流出血管以及膽管系統(tǒng)。在每一段的中心有門靜脈、肝動(dòng)脈及膽管分支,每一段的外圍有通過(guò)流出的肝靜脈,對(duì)于CT影像診斷,外科手術(shù),有著比較實(shí)用的意義和廣泛應(yīng)用。Bismuth分段法類似于Couinaud分段法,兩者之間差異很小,在北美地區(qū)較為流行。Bismuth分段法三條肝靜脈將肝臟分為四個(gè)扇形,然后繼續(xù)分段。這些扇形區(qū)以門靜脈為界,每個(gè)區(qū)由一支門靜脈供給。區(qū)域之間的分隔通常是肝靜脈。肝靜脈和門靜脈相互交織,如同兩只手的手指。左側(cè)門靜脈將肝臟分為兩個(gè)扇形區(qū)：前部分和后部分,左前扇區(qū)有兩個(gè)段：4段(肝方葉)和3段(左葉解剖的前部分)。這兩段由左肝裂或臍裂分隔,左側(cè)后扇區(qū)僅有一個(gè)2段,位于左葉的后方。Couinaud分段法中極少注意常見的解剖變異,尤其是右半肝。近年來(lái)的文獻(xiàn)報(bào)道證明肝內(nèi)管道的變異使Couinaud分段法不能真實(shí)反映肝臟內(nèi)部解剖結(jié)構(gòu),導(dǎo)致影像學(xué)定位錯(cuò)誤和影響肝臟手術(shù)方案的制定、實(shí)施。傳統(tǒng)分段方法是對(duì)尸體肝臟標(biāo)本的灌注鑄型后進(jìn)行研究,所獲得的解剖信息有限,臨床醫(yī)師很難在頭腦中形成一個(gè)立體、空間的印象。解剖的不清楚,導(dǎo)致了手術(shù)的復(fù)雜化、決策困難化、風(fēng)險(xiǎn)擴(kuò)大化。CT,MRI等二維影像技術(shù)的應(yīng)用改變了一維平片圖像的重疊等缺點(diǎn),但是在圖像的連續(xù)性、動(dòng)態(tài)顯示方面仍然沒(méi)有得到令人滿意的解決。隨著多層螺旋CT采集技術(shù)的發(fā)展及中國(guó)數(shù)字化虛擬人數(shù)據(jù)集的建立,國(guó)內(nèi)外各種3D醫(yī)療軟件相繼產(chǎn)生,三維重建可以重現(xiàn)人體骨骼,血管,內(nèi)臟,腫瘤的解剖位置,可以空間動(dòng)態(tài)觀察。然而,大多數(shù)的國(guó)外三維醫(yī)療軟件費(fèi)用昂貴,不能對(duì)感興趣區(qū)域進(jìn)行任意的顏色標(biāo)注、透明化、放大、縮小,不能任意角度進(jìn)行觀察,并且不具有模擬手術(shù)器械,不能模擬三維手術(shù),限制了其廣泛應(yīng)用。在國(guó)家高技術(shù)研究發(fā)展計(jì)劃(863計(jì)劃)項(xiàng)目；國(guó)家自然科學(xué)基金；廣東省自然科學(xué)團(tuán)隊(duì)項(xiàng)目；廣東省教育部產(chǎn)學(xué)研結(jié)合項(xiàng)目；廣東省中國(guó)科學(xué)院全面戰(zhàn)略合作項(xiàng)目等科研項(xiàng)目支持下,我們通過(guò)自主研發(fā)的3D醫(yī)學(xué)圖像可視化系統(tǒng)(Medical Image Three Dimensional Visualization System,MI-3DVS系統(tǒng)),基于64層以上螺旋CT提供亞毫米級(jí)的影像信息數(shù)據(jù),進(jìn)行100例活人體正常肝臟的薄層CT圖像數(shù)據(jù)的快速、準(zhǔn)確的個(gè)體化三維重建,根據(jù)肝內(nèi)門靜脈和肝靜脈變異及其分布,個(gè)體化肝臟分段、分類,并行術(shù)前虛擬軟件平臺(tái)仿真切肝,測(cè)定殘余肝臟體積,該研究使得對(duì)肝臟脈管系統(tǒng)變異、肝臟組織精準(zhǔn)可切除性評(píng)估成為可能,不僅改進(jìn)了傳統(tǒng)疾病的傳統(tǒng)診斷方式,使更多正常肝組織得以保留,還減少了術(shù)中出血、保存了更多的肝臟實(shí)質(zhì),降低切肝術(shù)后的并發(fā)癥的發(fā)生率和患者死亡率。術(shù)者可以在術(shù)前選擇最佳的手術(shù)方案,指導(dǎo)實(shí)際手術(shù)操作,實(shí)現(xiàn)了真正的數(shù)字化肝臟外科。同時(shí)基于17例腹部閉合性肝外傷患者的重建數(shù)據(jù)闡述MI-3DVS系統(tǒng)為核心的數(shù)字醫(yī)學(xué)技術(shù)在腹部閉合性肝外傷診治中的優(yōu)勢(shì)。第一部分 數(shù)字化肝臟分段導(dǎo)向下的個(gè)體化肝臟三維重建目的：1.研究MI-3DVS系統(tǒng)重建個(gè)體化肝臟的成像特點(diǎn)；2.研究100例活人體正常肝臟中肝門靜脈的正常和變異表現(xiàn)；3.研究上述100例活人體正常肝臟中肝靜脈的正常和變異表現(xiàn),依據(jù)變異的肝靜脈對(duì)肝臟個(gè)體化分段；4.探討數(shù)字化肝臟分段的意義。方法：1.研究對(duì)象及材料：(1)選取2013年1月1日至2015年1月1日期間,于我院行上腹部CT掃描體檢的100名健康志愿者64排CT腹部平掃+增強(qiáng)掃描,男性63人,女性37人,平均25歲(所有志愿者均簽訂知情同意書,經(jīng)南方醫(yī)科大學(xué)倫理委員會(huì)批準(zhǔn),符合醫(yī)療護(hù)理操作常規(guī))。肝功能正常,肝臟無(wú)器質(zhì)性病變。排除標(biāo)準(zhǔn)：1.肝動(dòng)脈、門靜脈、肝靜脈及下腔靜脈狹窄或閉塞者；2.門靜脈、肝靜脈、下腔靜脈顯影不良者；3.有X線檢查禁忌癥、對(duì)造影劑過(guò)敏者。(2)CT數(shù)據(jù)收集及研究設(shè)備、影像學(xué)掃描參數(shù)、藥品、數(shù)據(jù)采集方法、圖像三維重建方法參考(方馳華,周五一,虞春堂,等.肝臟管道系統(tǒng)灌注后薄層CT掃描和三維重建的研究[J].中華外科雜志,2004,42(9)：562-564.)。2.觀測(cè)肝門靜脈分支及變異類型,觀察肝靜脈分支及變異類型。3.個(gè)體化分段方法參照方馳華等發(fā)表過(guò)文獻(xiàn)介紹的立體選框法,當(dāng)門靜脈為正常型時(shí),我們根據(jù)肝靜脈分型變異進(jìn)行肝臟個(gè)體化分段,當(dāng)肝靜脈為正常型時(shí),我們根據(jù)門靜脈分型變異進(jìn)行個(gè)體化分段,分段的命名按順時(shí)針?lè)较蛞来蚊?對(duì)于本課題未發(fā)現(xiàn)的門靜脈變異類型及肝靜脈變異類型,或者門靜脈及肝靜脈均發(fā)生變異的數(shù)據(jù),本次研究不做為個(gè)體化分型對(duì)象。4.統(tǒng)計(jì)學(xué)方法：本研究主要為形態(tài)學(xué)描述,基本不涉及統(tǒng)計(jì)學(xué)推斷。結(jié)果：1.數(shù)字化門靜脈顯示效果統(tǒng)計(jì)：門靜脈三維重建模型結(jié)構(gòu)清晰、逼真、立體感強(qiáng)。肝門靜脈顯示率為100%,按照Couinaud門靜脈0-2級(jí)分支的方法,對(duì)100例健康自愿者門靜脈模型劃分為以下類型：正常型：門脈主干在肝門處分為左支和右支,右支向右側(cè)走行,分為右前支和右后支,82例,占82%；Ⅰ型變異：門脈主干在肝門處呈三叉狀,直接分為左支、右前支和右后支,14例,占14%。Ⅱ型變異：門靜脈右前支與門靜脈左支共干型,4例,占4%。未發(fā)現(xiàn)有關(guān)文獻(xiàn)報(bào)道的門靜脈右支缺如型及門靜脈左支水平段缺如型變異。2.數(shù)字化肝靜脈顯示效果統(tǒng)計(jì)：肝靜脈重建模型清晰、逼真、立體感強(qiáng),肝左、中、右靜脈顯示率為100%。肝靜脈的分型方法參照方馳華等前期的研究成果得出100健康自愿者肝靜脈總體分型如下：A型(左、中、右三支肝靜脈分別單獨(dú)匯入下腔靜脈)：41.0%(41/100),B型(肝左靜脈(LHV)和肝中靜脈(MHV)合成短干后再匯入下腔靜脈)：59.0%(59/100),C型(肝右靜脈(RHV)和肝中靜脈合成短干后再匯入下腔靜脈)在本次研究中未發(fā)現(xiàn)。肝右靜脈分型：A型(此型最常見,是一個(gè)主干和若干小分支)：78.0%(78/100),B型(肝右靜脈為一短干,伴有粗大的肝中靜脈起代償作用)：14.0%(14/100),C型(細(xì)小的肝右靜脈伴有一較粗大的直接匯入下腔靜脈的右后下靜脈(IRHV)):4.0%(4/100),D型(細(xì)小的肝右靜脈伴有一支細(xì)小的直接注入下腔靜脈的副肝右靜脈(ARHV))：4.0%(4/100)。肝右靜脈亞型：主要觀察肝右靜脈是否在根部即開始分支及分支的數(shù)目：Ⅰ型34.0%(34/100)：肝右靜脈在早期及根部無(wú)大的分支,僅有一個(gè)主干注入下腔靜脈,Ⅱ型56.0%(56/100)：肝右靜脈為一個(gè)主干,并在早期分成兩個(gè)粗細(xì)差異不大屬支,Ⅲ型6.0%(6/100)：肝右靜脈在下腔靜脈根部分成兩個(gè)粗細(xì)差異不大屬支,Ⅳ型8.0%(8/100)：肝右靜脈在下腔靜脈根部分成兩個(gè)粗細(xì)差異不大屬支,其中一個(gè)屬支再分成兩個(gè)粗細(xì)差異不大分支。肝中靜脈分型：A型78.0%(78/100)：此型最常見,肝中靜脈僅有一個(gè)主干和若干小分支；B型20.0%(20/100)：出現(xiàn)匯入肝中靜脈的Ⅳ段靜脈(Sg4V)；C型：Ⅳ段靜脈和臍靜脈同時(shí)匯入肝中靜脈(C型在本次研究中未發(fā)現(xiàn))；D型12.0%(12/100)：出現(xiàn)直接匯入下腔靜脈的Ⅳ段靜脈。肝左靜脈分型：A型82.0%(82/100)：此型最常見,為肝左靜脈僅有一個(gè)主干和若干小分支；B型18.0%(18/100)：出現(xiàn)匯入肝左靜脈的4段靜脈；C型：同時(shí)出現(xiàn)匯入肝左靜脈的Ⅳ段靜脈和臍靜脈(C型在本次研究中未發(fā)現(xiàn))。3.數(shù)字化個(gè)體化肝臟分段統(tǒng)計(jì)門靜脈正常型肝臟個(gè)體化分為8段與Couinaud分段法相同,Ⅰ型變異肝臟個(gè)體化分為7段,Ⅱ型變異肝臟個(gè)體化分為9段。肝靜脈正常型肝臟個(gè)體化分為8段與Couinand分段法相同,擁有4段肝靜脈的肝臟個(gè)體化分9段,擁有8段肝靜脈的肝臟個(gè)體化分9段,同時(shí)擁有4段及8段肝靜脈的肝臟個(gè)體化分10段,擁有右后下靜脈的肝臟個(gè)體化分9段。結(jié)論：1.基于64排螺旋CT肝靜脈增強(qiáng)掃描的數(shù)據(jù)集,使用MI-3DVS進(jìn)行數(shù)字化三維重建速度快、效果好,肝門靜脈、肝靜脈模型清晰、逼真、立體感強(qiáng)、可根據(jù)需要進(jìn)行隨意旋轉(zhuǎn)、透明化等操作；在個(gè)體化肝臟分段、手術(shù)風(fēng)險(xiǎn)評(píng)估、手術(shù)方式的選擇以及在臨床教學(xué)等方面都有很大的應(yīng)用價(jià)值。2.3D模型來(lái)源于活人體的圖像數(shù)據(jù),真實(shí)再現(xiàn)了肝臟、肝內(nèi)血管在體時(shí)的原始解剖位置關(guān)系,真正實(shí)現(xiàn)了活人體解剖數(shù)字化；第二部分 三維重建技術(shù)在腹部閉合性肝外傷診治中的應(yīng)用目的：1.利用MI-3DVS系統(tǒng)重建17例腹部閉合性肝外傷患者,觀察腹部閉合性肝外傷三維成像特點(diǎn)；2.將三維重建證明可以保守的患者進(jìn)行保守治療觀察療效；3.需要手術(shù)患者,將術(shù)中情況與術(shù)前三維重建對(duì)照,證明MI-3DVS系統(tǒng)可以明確外傷部位、血腫范圍、血管損傷情況,可以在術(shù)前幫助醫(yī)師決定手術(shù)方式、術(shù)式大小,在肝外傷診治方面體現(xiàn)三維重建的優(yōu)越性。方法：1.研究對(duì)象及材料：(1)收集我數(shù)字醫(yī)學(xué)中心2009年1月至2015年1月共17例(14名男性,3名女性；平均年齡,29歲)腹部閉合性肝外傷患者肝臟64排螺旋CT掃描數(shù)據(jù)(所有志愿者均簽訂知情同意書,經(jīng)南方醫(yī)科大學(xué)倫理委員會(huì)批準(zhǔn),符合醫(yī)療護(hù)理操作常規(guī))。(2)電腦系統(tǒng)及軟件配置同第一章。2.影像學(xué)掃描參數(shù)、數(shù)據(jù)采集、藥品、圖像三維重建方法同第一章。3.觀測(cè)肝臟內(nèi)部主要血管肝動(dòng)脈、肝靜脈、門靜脈損傷情況的相關(guān)數(shù)據(jù)。4.統(tǒng)計(jì)學(xué)方法：本實(shí)驗(yàn)主要為形態(tài)學(xué)描述,基本不涉及統(tǒng)計(jì)學(xué)推斷。結(jié)果：1.17例患者均為腹部閉合性肝外傷患者。14例患者術(shù)前三維重建模型表現(xiàn)出明顯的肝內(nèi)血管損傷,需要相應(yīng)的手術(shù)治療,術(shù)中發(fā)現(xiàn)情況與術(shù)前三維重建情況相對(duì)應(yīng)。3例術(shù)前三維重建模型沒(méi)有顯示肝內(nèi)血管損傷,患者成功的保守治療。全部17名患者痊愈出院。結(jié)論：1.腹部醫(yī)學(xué)圖像可視化系統(tǒng)(MI-3DVS)能快速有效的完成肝臟64排螺旋CT的三維數(shù)據(jù)的程序分割、三維重建,所完成的三維圖像能很好的反映肝臟的損傷情況,它使術(shù)者在術(shù)前對(duì)肝臟破裂有一個(gè)更全面的認(rèn)識(shí)和診斷,使手術(shù)更加精確,使患者得到及時(shí)準(zhǔn)確的救治,腹部醫(yī)學(xué)圖像系統(tǒng)在肝外傷診治中有良好的應(yīng)用前途。
[Abstract]:Background: the traditional liver segmentation method is based on morphologic anatomy based on the segmented liver appearance. On the surface of the diaphragm, the liver is divided into the left and right two leaves of the liver. This is different from the functional left, right or left, right Hemiliver. In the traditional segmentation method, the Chinese leaf belongs to the right lobe of the liver, and the function belongs to a part of the left lobe. Traditional division is a traditional part. The method does not show the internal vascular and bile duct structure. The advantage of this method is more intuitive, but it is not practical.1957 year Couinaud C based on the Glisson system in the liver distribution based on the Couinaud segmentation method, the liver is divided into left and right liver, five leaves and eight segments, and gradually in Asia and Europe. The segmental method is hepatic fissure and portal vein and hepatic vein. The liver is divided into 8 independent segments based on the functional anatomy. The right hepatic vein divides the liver into the right anterior and right posterior segments. The hepatic vein divides the liver into the left and right half (or left half liver and right hemi liver) from the inferior vena cava to the gallbladder fossa, and the left lobe of the liver is divided into the medial and lateral segments of the liver. The vein divides the liver into the upper, lower, left and right portal veins on the upper and lower branches into the center of each segment. The caudate leaves are both a leaf and a segment. Each segment of the liver is marked with Rome digital I - VIII, the first segment: the caudate leaf; the second segment: the upper left lateral lobe; the third segment: the left outer segment; the IV segment: fourth segment of Bismuth segment method (fourth segment method segment method (segment method). It is divided into 4A and 4B segment); V segment: right anterior inferior segment; section VI: right posterior inferior segment; Section VII: right posterior upper lobe; Section VIII: right anterior lobe, upper segment of right anterior lobe, serial number according clockwise. The Couinaud section is numbered according to clockwise direction. The advantage is that each segment is a independent unit, excise any segment without affecting the others. To ensure the survival of the liver, it is necessary to follow the vessels around these segments, that is, the excision line is parallel to the hepatic vein, so that the portal vein, the bile duct and the hepatic artery in the central position are retained. The segmental method is practical, each segment has an independent inflow and flow bleeding tube and the bile duct system. There is a portal vein at the center of each segment. The hepatic artery and the branch of the bile duct, with the outflow of the hepatic vein on the periphery of each segment, for CT imaging diagnosis and surgery, there are more practical significance and extensive application of the.Bismuth segmentation method similar to the Couinaud segmentation method. The difference between the two is very small. In North America, the three hepatic veins are divided into four branches of the liver, which is more popular in the North American area. These sector areas are bounded by the portal vein, each of which is supplied by a portal vein. The division of the region is usually the hepatic vein. The hepatic vein and the portal vein intertwined, like the fingers of two hands. The left portal vein divides the liver into two sectors: the anterior and posterior parts, and the left anterior sector with two segments: the 4 segment (liver Square). The 3 segments (the anterior part of the left leaf anatomy). These two segments are separated by left hepatic or umbilical cleft, only a 2 segment in the left posterior section of the left lobe. There is little attention to common anatomical variations in the left posterior.Couinaud section, especially in the right Hemiliver. In recent years, the literature has shown that the variation of the intrahepatic duct can not reflect the liver by the Couinaud segmentation method. The internal anatomical structure leads to the error of imaging localization and the formulation and implementation of the liver surgery program. The traditional segmentation method is to study the perfusion cast of the cadaver liver specimens. The anatomical information obtained is limited. The clinician is difficult to form a three-dimensional, spatial impression in the brain. The dissection is not clear, which leads to the recovery of the operation. The application of two-dimensional image technology, such as hybrid, difficult decision, risk enlargement,.CT, MRI, has changed the shortcomings of one dimension flat image, but it still has not been satisfactorily solved in the continuity and dynamic display of the image. With the development of multi-slice spiral CT acquisition technology and the establishment of digital virtual human data set in China, The internal and external 3D medical software has been produced in succession. The three-dimensional reconstruction can reproduce the human skeleton, blood vessels, viscera, and the anatomical position of the tumor. However, most of the foreign 3D medical software is expensive, and can not make any color mark on the region of interest, transparent, magnified, and narrow, and can not be observed at any angle. And do not have analog surgical instruments, can not simulate three-dimensional surgery, limited its wide application. In the national high-tech research and development plan (863 plan) project; National Natural Science Foundation; Guangdong province natural science team project; the Guangdong Ministry of Education Ministry of education, research and research projects; the comprehensive strategic cooperation project of the Chinese Academy of Sciences, Guangdong Province, etc. Under the support of the scientific research project, we use the independent 3D medical image visualization system (Medical Image Three Dimensional Visualization System, MI-3DVS system) to provide sub millimeter level image information data based on 64 layers of spiral CT, and carry out the rapid and accurate individualization of the thin layer CT image data of 100 cases of normal human normal liver. Reconstruction, according to the variation and distribution of the intrahepatic portal vein and the hepatic vein and its distribution, the individual liver segmentation, classification, and the parallel operation of the pre operation virtual software platform to simulate the liver cutting and determine the residual liver volume. This study makes the variation of the liver pulse tube system and the accurate resectability evaluation of the liver tissue as possible, not only improves the traditional diagnosis of traditional diseases. To preserve more normal liver tissue, reduce intraoperative bleeding, preserve more liver parenchyma, reduce the incidence of complications after hepatectomy and the patient's mortality. The operator can select the best surgical procedure before the operation, guide the actual operation and realize the true digital liver surgery. At the same time, 17 cases of abdominal closure are closed. The reconstruction data of the patients with liver injury describes the advantages of the MI-3DVS system as the core of digital medical technology in the diagnosis and treatment of closed abdominal trauma. Part 1 Digital liver segmented oriented individualized liver reconstruction: 1. study the imaging characteristics of the MI-3DVS system for the reconstruction of individual liver; and 2. study 100 cases of normal human normal human body. The normal and variant manifestations of the hepatic portal vein in the liver; 3. to study the normal and variant manifestations of the hepatic veins in the normal liver of the 100 living cases, according to the variation of the hepatic vein to the individual segment of the liver; 4. to explore the significance of the digital liver segmentation. Methods: 1. research objects and materials: (1) select the period from January 1, 2013 to January 1, 2015. 100 healthy volunteers in the upper abdomen of our hospital had 64 rows of CT abdominal plain scan + enhanced scan, 63 men and 37 women, with an average of 25 years old (all volunteers signed informed consent, approved by the Southern Medical University ethics committee, consistent with the regular medical care operation). The liver function was normal and the liver had no organic lesions. Exclusion criteria. 1. hepatic artery, portal vein, hepatic vein and inferior vena cava stenosis or occlusion; 2. portal vein, hepatic vein, inferior vena cava dysplasia; 3. X - ray contraindication, contrast agent allergy. (2) CT data collection and research equipment, imaging scanning parameters, medicine, data acquisition method, image 3D reconstruction method reference (Fang Chihua, Friday, Friday reference) One, Yu Chuntang, et al. A study of thin layer CT scan and three-dimensional reconstruction after hepatic duct system perfusion [J]. Chinese surgery magazine, 2004,42 (9):562-564.).2. observation of hepatic portal vein branch and variation type, observation of hepatic vein branch and variant type.3. individualized segmenting method referring to Fang Chi Hua et al. When the vein is normal, we subsection the liver according to the variant of the hepatic vein. When the hepatic vein is the normal type, we make individualized segmentation according to the variation of the portal vein. The nomenclature is named according to the clockwise direction. The type of portal vein variation and the variant type of the hepatic vein, or the portal vein, are not found in this subject. And the data of the variation of the hepatic vein, this study was not used as an individual.4. statistical method: This study was mainly a morphological description, basically without statistical inference. Results: 1. the results of digital portal vein display: the structure of the portal vein three-dimensional reconstruction model is clear, realistic and strong. The display rate of the hepatic portal vein is 100%, according to the method of the 0-2 branch of Couinaud portal vein, the portal vein model of 100 healthy volunteers was divided into the following types: normal type: the portal trunk was divided into the left and right branches at the hepatic portal, the right branch went to the right side, and the right branch was divided into right anterior and right posterior branches, 82 cases, 82%, and type I variation: the portal trunk was three forked at the hilum and directly divided. For the left, right anterior and right posterior branches, 14 cases accounted for 14%. type II variation: the right anterior branch of the portal vein and the left branch of the portal vein were co dried in 4 cases, accounting for the absence of the relevant documents reported on the deficiency of the right branch of the portal vein and the deficiency of the left level of the portal vein of the portal vein in the.2. digital hepatic vein, which showed a clear, realistic and stereoscopic model of the hepatic vein reconstruction model. Strong, left, middle, and right veins of the liver were displayed as the 100%. hepatic vein classification method referring to the previous research results of Fang Chihua and other prophase studies. The total hepatic vein classification of 100 healthy volunteers was obtained as follows: A (left, middle, right three branches of the hepatic vein respectively rejoining the inferior vena cava):41.0% (41/100), B type (LHV) and the middle hepatic vein (MHV) synthesis after the short dry after the short dry. :59.0% (59/100), type C (right hepatic vein (RHV) and hepatic vein synthesis after short dry vein to inferior vena cava) in this study was not found. The right hepatic vein classification: A (the most common type is a trunk and a number of small branches):78.0% (78/100), B (the right hepatic vein is a short dry, accompanied by a coarse hepatic vein compensatory). :14.0% (14/100), type C (small right hepatic vein with a larger right posterior inferior vena vein (IRHV) directly into the inferior vena cava): 4% (4/100), D (the right vein of the liver is accompanied by a tiny direct injection of the right vein of the inferior vena cava (ARHV)):4.0% (4/100). The right vein of the liver is subtype: the main observation is whether the right hepatic vein is in the right vein. The number of starting branches and branches: type I 34% (34/100): there is no large branch of the right vein in the early and root parts of the liver, only one trunk is injected into the inferior vena cava, type II 56% (56/100): the right hepatic vein is a trunk, and in the early stage, the difference of the two coarse and fine branches is not a branch, and type III 6% (6/100): the right hepatic vein is in the inferior vena cava. The difference of two coarse and fine differences is not a branch, and type IV 8% (8/100): the right hepatic vein is divided into two coarse and fine branches in the root of the inferior vena cava, one of which is divided into two coarse and fine different branches. The middle hepatic vein type is A type 78% (78/100): this type is the most common, the middle hepatic vein is only one trunk and a number of small branches; type B 20 .0% (20/100): the vein IV vein (Sg4V) into the middle hepatic vein (Sg4V); C type IV and the umbilical vein to the middle hepatic vein (type C is not found in this study); D 12% (12/100): the IV vein of the inferior vena cava, the hepatic left vein type: A type 82% (82/100): this type is the most common, only the left hepatic vein of the liver. One trunk and a number of small branches; type B 18% (18/100): the 4 vein of the hepatic left vein; C type: the IV and the umbilical veins of the left vein of the liver (type C not found in this study) the.3. digitized individual hepatic segmental portal normal liver was divided into 8 segments, which were the same as that of the Couinaud subsection. The individual variant liver of type I was divided into 7 segments, and the individualization of type II variant liver was divided into 9 segments. The normal liver of the hepatic vein was divided into 8 segments, which were the same as that of the Couinand segment. There were 9 segments of the liver with 4 segments of the hepatic vein, 9 segments of the liver with 8 segments of the hepatic vein, and 10 segments of the liver of 4 and 8 segments of the liver. There are 9 segments of the liver in the right posterior inferior vein. Conclusion: 1. based on the data set of the 64 row spiral CT liver vein enhancement scan, the digital 3D reconstruction is fast and effective using MI-3DVS. The hepatic portal vein, the hepatic vein model is clear, realistic and strong, and can be rotated freely and transparently according to the need. The.2.3D model is derived from live surgery.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 彭豐平;鮑蘇蘇;;CT序列圖像中肝臟及其管道的分割[J];計(jì)算機(jī)工程與應(yīng)用;2009年20期

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本文編號(hào)：1836359