CAJ | 학술논문

目的探讨肝内血管三维(3D)成像在肝癌局部切除中的意义.方法将64排螺旋CT扫描获得的肝癌患者的肝脏二维图像数据,以DICOM文件格式导入3D模拟系统进行肝内血管3D重建;在重建的肝内血管3D图像指导下行肝癌局部肝切除.结果 (1)经过重建得到了清晰的肝内血管以及肝脏和肝癌的3D图像,该图像立体地显示了肝癌与周围诸血管的解剖关系.(2)在3D图像上模拟不同肿瘤切缘宽度得到肝癌周围肝动脉、门静脉和肝静脉的切断平面和各血管切断后所影响的肝组织体积.(3)分析肿瘤的切缘宽度与切肝体积间的关系,拟定出肝癌局部切除的最佳切肝平面.(4)按拟定的切肝平面行实际肝切除,切除标本体积为178 ml,肿瘤切缘为9 mm,结果与术前模拟完全吻合.结论在肝内血管3D图像指导下,肝癌的局部切除可以按肿瘤周围血管的解剖精确进行;通过术前模拟可以找到最佳肝切除平面.
목적 탐토간내혈관삼유(3D)성상재간암국부절제중적의의.방법 장64배라선CT소묘획득적간암환자적간장이유도상수거,이DICOM문건격식도입3D모의계통진행간내혈관3D중건;재중건적간내혈관3D도상지도하행간암국부간절제.결과 (1)경과중건득도료청석적간내혈관이급간장화간암적3D도상,해도상입체지현시료간암여주위제혈관적해부관계.(2)재3D도상상모의불동종류절연관도득도간암주위간동맥、문정맥화간정맥적절단평면화각혈관절단후소영향적간조직체적.(3)분석종류적절연관도여절간체적간적관계,의정출간암국부절제적최가절간평면.(4)안의정적절간평면행실제간절제,절제표본체적위178 ml,종류절연위9 mm,결과여술전모의완전문합.결론 재간내혈관3D도상지도하,간암적국부절제가이안종류주위혈관적해부정학진행;통과술전모의가이조도최가간절제평면.
Objective To evaluate three-dimensional (3D) image of intrahepatic vessels in anatomic local resection of hepatocellular carcinoma (HCC). Methods The two-dimensional (2D) image date sets of the liver of a HCC patient, obtained by 64 row helical CT scan, were transmitted to a 3D simulation system for 3D reconstruction of intrahepafic vessels. Under the guidance of these 3D images, an actual local resection for HCC was performed. Results (1) The integrated 3D images of the hepatic artery, portal vein, hepatic vein as well as liver parenchyma and tumor were reconstructed, which visualized the detailed 3D vascular structure in the area of the tumor. (2) On the 3D images, the different cutting planes of hepatic artery, portal vein and hepatic vein were marked corresponding to different surgical margins and the involved liver volumes were calculated. (3) By balancing between the surgical margins and the liver volumes to be resected, the cutting points of hepatic artery, portal vein and hepatic vein were selected, which determined the transection plane for local resection of the HCC. (4) Based on the preoperative planning, a local resection for HCC was successfully performed with a resected specimen volume of 178 ml and a surgical circumferential margin of 9ram, which were highly in accordance with the simulating results. Conclusions Preoperative 3D imaging to visualize the anatomic structures of the tumor region make it possible to perform tumor local resection anatomically and preoperative simulation is of great value in determining an optimal transecting plane during the process of hepatectomy.