目的 应用CT三维重建描述肝静脉引流形式，为肝外科的术前规划与术中操作提供影像解剖学参考。 方法 回顾性随机收集406例腹部增强CT图像，使用容积重建（volume reconstruction，VR）、多平面重组（multiplanar reformation，MPR）与最大密度投影（maximum-intensity projection，MIP）等图像后处理技术观察肝静脉解剖形态，对其进行细致分型。 结果 （1）肝静脉3大主干汇入下腔静脉的方式分为4型：分别汇入型23.2%（94例），左中合干型75.1%（305例），右中合干型0.7%（3例），共干型1%（4例）；（2）肝左静脉分为3型：I型7.1%（29例），II型80.6%（327例），III型12.3%（50例）；（3）肝中静脉分为4型：I型93.1%（378例），II型3.5%（14例），III型1.2%（5例），IV型2.2%（9例）；（4）肝右静脉分为3型：I型44.1%（179例），II型50%（203例），III型5.4%（22例）。 结论 肝静脉解剖类型多样化，VR、MPR及MIP能很好地显示肝静脉属支及其走形，为肝手术的术前规划和术中操作提供可靠的解剖学依据。
Abstract
Objective To describe the types of hepatic venous drainage by 3D reconstructed CT images, so as to provide anatomical reference for preoperative preparation and intraoperative guidance of hepatic surgery. Methods A total of 406 contrast-enhanced CT images of the abdomen were collected randomly. The anatomic morphology of hepatic veins and the type classification were observed and analyzed by volume reconstruction (VR), multiplanar reformation (MPR), and maximum-intensity projection (MIP). Results The anatomic morphology of hepatic veins (HVs) draining into the inferior vena cava (IVC) was classified into the following four types. Type I: non-trunk type of the left, middle and right HVs, accounting for 23.2% (94). Type II: trunk type of left and middle HVs, accounting for 75.1% (305). Type III: trunk type of right and middle HVs, accounting for 0.7% (3). Type IV: trunk type of left, middle and right HVs, accounting for 1% (4). The left hepatic vein was classified into three types. Type I accounting for I7.1% (29), Type II accounting for 80.6% (327), Type III accounting for 12.3% (50). The middle hepatic vein was classified into four types. Type I accounting for 93.1% (378), Type II accounting for 3.5% (14), Type III accounting for 1.2% (5), Type IV accounting for 2.2% (9). The right hepatic vein was classified into three types. Type I accounting for 44.1% (179), Type II accounting for 50% (203), Type III accounting for 5.4% (22). Conclusions Hepatic veins have a variety of types. Venous tributaries could be displayed clearly by VR、MPR and MIP, which will provide reliable anatomical evidence for preoperative preparation and intraoperative guidance of hepatic surgery.
关键词
肝静脉 /
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分型 /
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三维重建 /
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CT
Key words
Hepatic vein /
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Typing /
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Three-dimensional reconstruction /
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CT
中图分类号：
R445.3
R322.48
R322.123
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