余辉 张军

摘要：目的：评价128层螺旋CT VR图像融合重建技术在肝精确切除术前评估的应用。方法：用128层螺旋CT VR图像融合重建技术收集2017年7月至2020年7月深圳市龙岗区人民医院收治的 11例原发性肝癌患者影像数据，对肝脏、肿瘤、肝动脉、门静脉、肝静脉CT增强数据分别进行VR重建。对各重建图像进行多色彩编码，再进行多组图像融合，显示肝脏、病灶、肝血管之间的关系，并进行肝脏、病灶体积等测量，分析各项测量数据。在融合图像上进行虚拟切除手术，选择合理手术方案，最后将系统测量各数据分别与传统的肝脏二维测量技术所测数据和术中实际切除情况进行分析对比。结果：11例患者实际术式均与术前规划虚拟手术方案一致，11例患者术后均未发生肝功能衰竭、出血、胆汁瘘等严重并发症，2例患者出现了术后胸腔积液，予以穿刺引流后恢复。结论：128层螺旋CT VR图像融合重建技术在肝精确切除术前评估中有很大的应用价值，有利于优化精准肝切除手术方案的选择。

关键词：128层CT;三维重建;融合重建;原发性肝癌;精准肝切除;手术规划

中图分类号：R735.7文献标识码：BDOI：10？郾3969/j.issn.1001-0270.2021.03.10

Abstract： Objective： To evaluate the application of 128 slice spiral CT VR Multi Objects in preoperative accurate liver resection. Methods： 128 slice spiral CT VR Multi Objects was used to collect the clinical data from July 2017 to July 2020 Longgang District Peoples hospital of ShenzhenFor the image data of 11 patients with primary liver cancer， VR reconstruction was performed on the enhanced CT data of liver， tumor， hepatic artery， portal vein and hepatic vein respectively. Multi color coding was performed on the reconstructed images， and then multi group image fusion was performed to show the relationship between liver， lesion and hepatic blood vessel. The volume of liver and lesion was measured， and the measurement data were analyzed to improve the fusion image Finally， the data measured by the system were compared with the data measured by the traditional two-dimensional liver measurement technology and the actual resection situation. Results： the actual operation mode of 11 patients was consistent with the preoperative planning of virtual operation scheme. No serious complications such as liver failure， bleeding， bile fistula occurred in 11 patients. 2 patients had postoperative pleural effusion， which was recovered after puncture and drainage. Conclusion： 128 slice spiral CT VR Multi Objects has great application value in the preoperative evaluation of precise hepatectomy， which is conducive to optimizing the choice of precise hepatectomy.

Key Words： 128 slice CT; three dimensional reconstruction; Multi Objects; primary liver cancer; precise hepatectomy; operation planning

肝腫瘤的手术治疗理念在不断进步，以“最小创伤侵袭和最大肝脏保护，获取最佳康复效果”的精准肝切除（precision liver resection）为肝肿瘤外科治疗的理想目标[1]。董家鸿（2009）[2]提出了精准肝切除的概念和内涵，使得精准肝切除理念进一步具体和标准化。要做到精准切除，术前评估尤为重要。术前精准、全面的影像学评估，把握切除肝脏的体积和术区血管、胆道解剖的关系，则是肝精准切除术前评估的重中之重，有着十分重要的临床意义[3]。……