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目的通过研究在体肝脏的CT重建图像,确定肝脏左内侧叶IVa、IVb亚段间的分界及走行在两亚段之间的肝静脉属支。方法采用容积再现(volume rendering,VR)和最大密度投影(maximum intensity projection,MIP)两种方法,对49例在体肝脏CT扫描图像进行肝内血管的三维重建,寻找肝脏左内侧叶IVa、IVb两亚段间分界及走行在段间裂内的肝静脉属支及其汇入部位。结果在VR和NIP两种重建图像上,作为两亚段分界标志的肝静脉属支出现率分别为14.29%和87.75%,因此采用MIP法重建出的三维图像对于寻找肝内细小血管分支更适用。该支肝静脉属支的汇入部位可分为以下3种情况:①汇入肝中静脉主干有24例,占55.81%;②汇入肝中静脉左根有16例,占37.21%;③汇入肝左静脉有3例,占6.98%。结论通过CT三维重建图像可以确定肝脏IVa、IVb两亚段间分界,并且走行在该分界位置的肝静脉属支可作为两亚段间的分界标志,结果为临床上涉及肝脏左内侧叶IVa、IVb亚段的肝脏外科手术提供形态学依据。
OBJECTIVE: To determine the boundaries between the segments IVa and IVb of the left medial lobe of the liver and the branches of the hepatic vein running between the two sub-segments by studying CT reconstruction images in vivo. Methods Volume rendering (VR) and maximum intensity projection (MIP) were used to reconstruct intrahepatic vessels from 49 CT images of liver in vivo. Two sub-section of the boundary and walk in the inter-section hepatic venous branches and its import parts. Results In the two reconstructed images of VR and NIP, the prevalence rates of hepatic veins were 14.29% and 87.75%, respectively. Therefore, the three-dimensional images reconstructed by MIP method were more suitable for finding the small blood vessel branches in the liver . The branch of the branch of hepatic vein into the site can be divided into the following three cases: ① remitted to the trunk of the middle of the liver there are 24 cases, accounting for 55.81%; ② remitted to the left middle hepatic vein in 16 cases, accounting for 37.21%; ③ Import liver left ventricle in 3 cases, accounting for 6.98%. Conclusion The three-dimensional reconstruction of CT images can determine the boundaries between the two sublines IVa and IVb in the liver and the branches of the hepatic vein running at the boundary can serve as the boundary markers between the two sub-sections. The results are clinically relevant to the left medial lobe of the liver IVa, IVb sub-section of liver surgery to provide a morphological basis.