MSCT与标本制作新技术在肝脏分段解剖研究中的应用及其价值
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摘要
目的：
探讨多层螺旋CT肝脏血管成像技术与标本制作新技术的联合应用在肝脏分段中的价值，探讨门静脉与肝静脉的关系，提出合理的肝脏分段方法。
材料和方法：
1．实验材料：
新鲜人尸体离体肝脏15个，对比剂(优维显300)，铸型剂JF(聚合树脂的一种)，硅胶，发泡剂，油画染料及纺织染料、水粉染料若干，20％福尔马林溶液，15％盐酸溶液，聚酯共聚体P45。设备：16层螺旋CT(Philips AG，Holand)，真空浸渗箱，压力表，排气阀，电动带锯，低温冰箱，聚酯塑料网，聚酯塑料箱，辅助品(钢化玻璃、PE管、硅胶管、燕尾夹)。
2．临床资料
2005，10～2006，1月间对200余例患者行三期64层螺旋CT(siemens sensation cardiac 64)肝脏扫描，从中选择出肝脏没有明显病变，对肝脏解剖无影响的病例32例，其中8例由于肝静脉或门静脉显影欠佳而被弃用，仅对肝静脉与门静脉均显影良好的24例患者图像进行分段研究。
3．方法：
3．1．人体肝脏门静脉铸型标本的制作
OBJECTIVE:
To evaluate the value of MSCT angiography combined with new specimen- making technology inliver segmental anatomy and the relationship between hepatic and portal veins, and suggest a reasonable method for radiological delineation of segmental and subsegmental anatomy of theliver. MATERIALS AND METHODS
1. experimental materials
15 fresh human cadaver livers, contrast media (Ultravist 300) , acrylic resin, silicone, polyurethane foam, colourant, P45; 16- slice spiral CT scanner (Philips AG, Holand), vacuum saturated box , pressure gage , air evacuation valve, band saw (ribbon), refrigerator, polyester plastics net and box, assistant (tempered glass , PE tube silica tube, swallow tail clip).
2. clinical materials
From October 2005 to January 2006, 200 consecutive patients underwent triphasic contrast-enhanced spiral CT examination using 64-slice spiral CT scanner. Of these 200 patients, 32 patients met the following inclusion criteria: no lesions in the liver, no
探讨多层螺旋CT肝脏血管成像技术与标本制作新技术的联合应用在肝脏分段中的价值，探讨门静脉与肝静脉的关系，提出合理的肝脏分段方法。
材料和方法：
1．实验材料：
新鲜人尸体离体肝脏15个，对比剂(优维显300)，铸型剂JF(聚合树脂的一种)，硅胶，发泡剂，油画染料及纺织染料、水粉染料若干，20％福尔马林溶液，15％盐酸溶液，聚酯共聚体P45。设备：16层螺旋CT(Philips AG，Holand)，真空浸渗箱，压力表，排气阀，电动带锯，低温冰箱，聚酯塑料网，聚酯塑料箱，辅助品(钢化玻璃、PE管、硅胶管、燕尾夹)。
2．临床资料
2005，10～2006，1月间对200余例患者行三期64层螺旋CT(siemens sensation cardiac 64)肝脏扫描，从中选择出肝脏没有明显病变，对肝脏解剖无影响的病例32例，其中8例由于肝静脉或门静脉显影欠佳而被弃用，仅对肝静脉与门静脉均显影良好的24例患者图像进行分段研究。
3．方法：
3．1．人体肝脏门静脉铸型标本的制作
OBJECTIVE:
To evaluate the value of MSCT angiography combined with new specimen- making technology inliver segmental anatomy and the relationship between hepatic and portal veins, and suggest a reasonable method for radiological delineation of segmental and subsegmental anatomy of theliver. MATERIALS AND METHODS
1. experimental materials
15 fresh human cadaver livers, contrast media (Ultravist 300) , acrylic resin, silicone, polyurethane foam, colourant, P45; 16- slice spiral CT scanner (Philips AG, Holand), vacuum saturated box , pressure gage , air evacuation valve, band saw (ribbon), refrigerator, polyester plastics net and box, assistant (tempered glass , PE tube silica tube, swallow tail clip).
2. clinical materials
From October 2005 to January 2006, 200 consecutive patients underwent triphasic contrast-enhanced spiral CT examination using 64-slice spiral CT scanner. Of these 200 patients, 32 patients met the following inclusion criteria: no lesions in the liver, no
引文
1 刘树伟．使用国际公认的肝段划分法[J]临床医学影像学杂志1995；6(2)：92-94．
2 Couinaud C, Surgical Anatomy of the Liver Revisited. [M]Paris, Couinaud, 1989;
3 Bismuth H. Surgical anatomy and anatomical surgery of the liver.[J] World J. Surg. 1982; 6: 3-9
4 韩国宏，郭庆林．肝脏分段的解剖基础及其变异研究进展[J]国外医学临床放射学分册1998；6：344-347．
5 Deshpande RR, Heaton ND, Rela M. Surgical anatomy of segmental liver transplantation[J] Br J Surg. 2002; 89(9): 1078-88.
6 Fasel JH, Selle D, Evertsz CJ, et al. Segmental Anatomy of the Liver: Poor Correlation with CT.[J] Radiology. 1998; 206(1): 151-6
7 Strunk H, Stuckmann G, Textor J, et al. Limitations and pitfalls of Couinaud's segmentation of the liver in transaxial Imaging.[J] Eur Radiol. 2003 Nov; 13(11): 2472-82. Epub 2003 May
8 Soyer P, Bluemke DA, Bliss DF, et al. Surgical segmental anatomy of the liver: demonstration with spiral CT during arterial portography and multiplanar reconstruction. [J]AJR 1994; 163: 99-103.
9 王茂春，彭吉润，冷希圣，等．计算机行肝脏CT断层三维重建及测量在肝癌中的应用研究[J]中国医学影像技术2003；19(12)：1735-1738．
10 Togo S, Shimada H, Kanemura E, et al. Usefulness of three-dimensional computed tomography for anatomic liver resection: sub-subsegmentectomy.[J] Surgery. 1998; 123(1): 73-8.
11 张忠嘉，马大庆．肝段的解剖学划分及其影像学显示(综述)[J]国外医学临床放射学分册1996；5：276-278．
12 刘学静，武乐斌，柳澄．多层螺旋CT门静脉成像及其在肝脏解剖分段中的应用[J]医学影像学杂志2002；12(5)：398-400．
13 方驰华，周五一，虞春堂，等．肝脏管道系统灌注后薄层CT扫描和三维重建的研究[J]中华外科学杂志；2004，42(9)：562-565．
14 Balaji MC, Kalita AJ, Ravindranath K, et al. Computed Tomography Angiography Demonstration of Portal Vein Anomaly Type V[J] J Comput Assist Tomogr. 2004; 28(3): 348-50.
15 Ortale JR, Naves De Freitas Azevedo CH, Mello De Castro C. Anatomy of the intrahepatic ramification of the portal vein in the right hemiliver.[J]Cells Tissues Organs. 2000; 166(4): 378-87.
16 Fischer L, Cardenas C, Thorn M, et al. Limits of Couinaud's Liver Segment Classification: A Quantitative Computer-Based Three-Dimensional Analysis.[J] Journal of Computer Assisted Tomography. 2002; 26(6): 962-7.
17 Van Leeuwen MS, Noordzij J, Fernandez MA. Portal venous and segmental anatomy of the right hemiliver: observation based on three dimensional spiral CT renderings.[J] AJR. Am. J. Roentgenol. 1994; 163: 1395-1404
18 Rubin GD, Dake MD, Napel SA. Three-dimensiomal spiral CT angiography of the abdomen: initial clinical experience.[J] Radiology 1993; 186: 147-152
19.Cho A, Okazumi S, Takayama W. Anatomy of the right anterosuperior area(segment 8) of the liver: evaluation with helical CT during arterial portography. [J]Radiology 2000; 214: 491-495
20 Soyer P, Roche A, Gad M. Preoperative segmental localization of hepatic metastases: utility of three-dimensional CT during arterial portography. Radiology[J]1991; 180: 653-658
21 Moran BJ, O'Rourke N, Plant GR et al. Computed tomographic portography in preoperative imaging of hepatic neoplasms.[J] Br J Surg. 1995; 82(5): 669-671.
22 吴东，周康荣，陈祖望．螺旋CT门静脉造影准直和成像方法的合理选择．[J] 临床放射学杂志，2000，19：40-43
23 刘学静，武乐斌，柳澄．多层螺旋CT门静脉造影术准直与螺距匹配及重建方法优化选择 中国医学影像技术 2004(20)12：1933-1936
24 Soyer P, Heath D, Bluemke DA et al. Three-dimensional helical CT of intrahepatic venous structures: comparison of three rendering techniques. [J]Comput Assist Tomogr. 1996; 20(1): 122-127.
25 Thomas G. Flohr, Stefan Schaller, Karl Stierstorfer, et al. Multi-Detector Row CT Systems and Image-Reconstruction Techniques.[J] Radiology 2005; 25(2): 756-773;
26 柳澄 秦维昌．多层螺旋CT(一)、(二)[J]医学影像学杂志，2000，10(3)：194-195；2001，11(1)：53-54
27 刘学静 武乐斌 柳澄 多层螺旋CT肝门静脉成像及其临床应用价值[J]中国临床解剖学杂志，2004，22(5)：478-480
28 杨建荣，云玉珍，张宝林 正常成人肝内静脉系的解剖及螺旋CT血管成像的对照研究[J]中国临床医学影像杂志．．2005；16(3)：167-169．
29 韩国宏，郭庆林．肝脏段的解剖基础及其变异研究进展[J]国外医学临床放射学分册1998；6：344-347
30 AG Heriot, ND Karanjia. A review of techniques for liver resection[J]Ann R Coll Surg Engl. 2002; 84: 371-380.
31．张大海，顾伟中．肝脏的功能解剖和CT定位[J]临床放射学杂志1999；18(6)：374-375．
32 皮执民，王心见．肝脏手术的历史回顾[J]中国现代手术学杂志．2003，7(2)：156-158．
33 严律南．肝脏外科新进展．[J]中华外科杂志；2004，12(1)：10-11．
34 Hjortsj CH. The topography of the intrahepatic duct system[J]. Acta Anat (Basel). 1951; 11: 599-615.
35 中国肝脏专家组．肝脏解剖和肝脏手术切除术统一名称[J]中华外科杂志．2002；40(5)：339-341．
36 David C. Madoff, MD; Marshall E. Hicks, MD; Jean-Nicolas Vauthey, MD; et al. Transhepatic Portal Vein Embolization: Anatomy, Indications, and Technical Considerations.[J] RadioGraphics 2002; 22(5): 1063-1076.
37 Deshpande RR, Heaton ND, Rela M. Surgical anatomy of segmental liver transplantation[J] Br J Surg. 2002; 89(9): 1078-88.
38 Goldsmith NA, Woodburne RT. The surgical anatomy pertaining to liver resection[J]. Surg Gynecol Obstet, 1957; 105: 310-318.
39 Bismuth H. Surgical anatomy and anatomical surgery[J]. World J Surg, 1982, 6: 3-9.
40 王杰，王学浩，赵志泉，等．多学科统一的肝段解剖命名新建议[J]中华肝脏病杂志2002：10(2)：115．
41 Couinaud C. Surgical anatomy of the liver revisited Ch 4. Anatomy of the Dorsal Sector of the Liver. New Considerations on Liver Anatomy.[J] Paris: Pers Ed.1989; 26-39.
42 David C. Madoff, MD; Marshall E. Hicks, MD; Jean-Nicolas Vauthey, MD; et al. Transhepatic Portal Vein Embolization: Anatomy, Indications, and Technical Considerations.[J] RadioGraphics 2002; 22(5): 1063-1076.
43 Takayasu K, Moriyama N, Muramatsu Y. Intrahepatic portal vein branches studied by percutaneous transhepatic portography.[J] Radiology, 1985; 154: 31-36.
44.Inoue T, Kinoshita H, Hirohashi K, et al. Ramification of the intrahepatic portal vein identified by percutaneous transhepatic portography. [J]World J Surg 1986; 10: 287-93.
45 van Leeuwen MS, Noordzij J, Femandez MA, et al. Portal venous and segmental anatomy of the right hemiliver: observation based on threedimensional spiral CT renderings.[J] AJR 1994; 163: 1395-404.
46 金武男，杨香．．螺旋CT三维重建对各肝段门静脉解剖结构的观察[J]中国医学影像技术．2003；19(6)：692-695．
47 Ohashi I, Ina H, Okada Y, et al. Segmental anatomy of the liver under the right diaphragmatic dome: evaluation with axial CT.[J] Radiology, 1996; 200: 779-783.
48 Kogure K, Kuwano H, Fujimaki N, et al. Reproposal for Hjortsjo's segmental anatomy on the anterior segment in human liver. [J]Arch Surg, 2002; 137: 1118-24.
49 Cho A, Okazumi S, Makino H, et al. Relation between hepatic and portal veins in the right paramedian sector: proposal for anatomical reclassification of the liver.[J] World J Surg 2004; 28: 8-12.
50 Cho A, Okazumi S, Miyazawa Y, et al. Proposal for a reclassification of liver based anatomy on portal ramifications.[J] American J Surg 2005: 189: 195-199.
51 刘树伟，于台飞，王新怡，等．肝段在横断面上的划分：断层标本与磁共振图像对照研究[J]中国临床解剖学杂志．1996；14(1)：33-37．
52 刘树伟，马祥兴，刘汉明，等．Couinaud肝段在CT图像上的划分[J]临床医学影像杂志．1996：7(1)：10，31-32．
1．裘法祖等主编[M]腹部外科临床解剖学，第一版济南 山东科学技术出版社，2001：146-153
2. Fasel JH, Selle D, Evertsz CJ, et al. Segmental Anatomy of the Liver: Poor Correlation with CT. [J] Radiology. 1998;206(1): 151- 6
3．吴东，周康荣，陈祖望．螺旋CT门静脉造影准直和成像方法的合理选择．[J]临床放射学杂志，2000，19：40-43
4．王东，张挽时，熊明辉等．螺旋CT门静脉血管造影扫描参数和成像方法的优化[J]医学影像学杂志，2001，11(6)：352-355
5. Van-Leeuwen MS, Noordzij J, Femandez MA, et al.Portal venous and segmental anatomy of the right hemiliver:Observations based on three-dimensional spiral CT renderings. AJR, 1994,163:1395
6. Chopra S, Ghiatas AA, Encamacion CE, et al. Transjugular intrahepatic portosystemic sHunts: Assessment with helical CT Angiography. Radiology, 1997,202(1):277-280
7. Chambers TP, Baron RL, Lush RM.Hepatic CT enhancement. PartⅡ. Alterations in contrast material volume and rate of injection within the same patients. [J] Radiology, 1994,193(2): 518-522
8. Dushyant S, Sanjay S, Constantino P, et al. Using multidetector CT for preoperative vascular evaluation of liver neoplasms: technique and results. [J] AJR, 2002:179:53-59
9．严福华，曾蒙苏，周康荣，等．螺旋CT肝脏检查技术参数的选择．[J]临床放射学杂志，1996，15(8)：290-293
10. Chambers TP, Baron RL,Lush RM.Hepatic CT enhancement.Part Ⅰ. Alterations in the volume of contrast material within the same patients. [J] Radiology, 1994,193(2): 513-517
11. Rubin GD, Shiau MC, Leung AN, et al. Aorta and iliac arteries: single versus multiple detector-row helical CT angiography. Radiology, 2000,215(3):670-676
12．刘学静，武乐斌，柳澄多层螺旋CT门静脉造影术准直与螺距匹配及重建方法优化选择 中国医学影像技术2004(20)12：1933-1936
13. Soyer P, Heath D, Bluemke DA et al. Three-dimensional helical CT of intrahepatic venous structures: comparison of three rendering techniques. [J] Comput Assist Tomogr.1996;20(1):122-127.
14．柳澄秦维昌．多层螺旋CT(一)、(二)[J]医学影像学杂志，2000，10(3)：194-195；2001，11(1)：53-54
15．刘学静、武乐斌、柳澄等．多层螺旋CT肝门静脉成像及其临床应用价值 中国临床解剖学杂志2004(22)5：478-480
16. Oshimi F, Hasegawa H, Koizumi S, et al. Application of three-dimensional spiral computed tomographic angiography to pancreatoduodenectomy for cancer. [J] Br J Surg, 1995,82(1): 116-117
17. Soyer P, Roche A, Gad M, et al. Preoperative segmental localization of hepatic metastases: utility of three-dimensional CT during arterial portography. [J] Radiology, 1991,180(3):653-658
2 Couinaud C, Surgical Anatomy of the Liver Revisited. [M]Paris, Couinaud, 1989;
3 Bismuth H. Surgical anatomy and anatomical surgery of the liver.[J] World J. Surg. 1982; 6: 3-9
4 韩国宏，郭庆林．肝脏分段的解剖基础及其变异研究进展[J]国外医学临床放射学分册1998；6：344-347．
5 Deshpande RR, Heaton ND, Rela M. Surgical anatomy of segmental liver transplantation[J] Br J Surg. 2002; 89(9): 1078-88.
6 Fasel JH, Selle D, Evertsz CJ, et al. Segmental Anatomy of the Liver: Poor Correlation with CT.[J] Radiology. 1998; 206(1): 151-6
7 Strunk H, Stuckmann G, Textor J, et al. Limitations and pitfalls of Couinaud's segmentation of the liver in transaxial Imaging.[J] Eur Radiol. 2003 Nov; 13(11): 2472-82. Epub 2003 May
8 Soyer P, Bluemke DA, Bliss DF, et al. Surgical segmental anatomy of the liver: demonstration with spiral CT during arterial portography and multiplanar reconstruction. [J]AJR 1994; 163: 99-103.
9 王茂春，彭吉润，冷希圣，等．计算机行肝脏CT断层三维重建及测量在肝癌中的应用研究[J]中国医学影像技术2003；19(12)：1735-1738．
10 Togo S, Shimada H, Kanemura E, et al. Usefulness of three-dimensional computed tomography for anatomic liver resection: sub-subsegmentectomy.[J] Surgery. 1998; 123(1): 73-8.
11 张忠嘉，马大庆．肝段的解剖学划分及其影像学显示(综述)[J]国外医学临床放射学分册1996；5：276-278．
12 刘学静，武乐斌，柳澄．多层螺旋CT门静脉成像及其在肝脏解剖分段中的应用[J]医学影像学杂志2002；12(5)：398-400．
13 方驰华，周五一，虞春堂，等．肝脏管道系统灌注后薄层CT扫描和三维重建的研究[J]中华外科学杂志；2004，42(9)：562-565．
14 Balaji MC, Kalita AJ, Ravindranath K, et al. Computed Tomography Angiography Demonstration of Portal Vein Anomaly Type V[J] J Comput Assist Tomogr. 2004; 28(3): 348-50.
15 Ortale JR, Naves De Freitas Azevedo CH, Mello De Castro C. Anatomy of the intrahepatic ramification of the portal vein in the right hemiliver.[J]Cells Tissues Organs. 2000; 166(4): 378-87.
16 Fischer L, Cardenas C, Thorn M, et al. Limits of Couinaud's Liver Segment Classification: A Quantitative Computer-Based Three-Dimensional Analysis.[J] Journal of Computer Assisted Tomography. 2002; 26(6): 962-7.
17 Van Leeuwen MS, Noordzij J, Fernandez MA. Portal venous and segmental anatomy of the right hemiliver: observation based on three dimensional spiral CT renderings.[J] AJR. Am. J. Roentgenol. 1994; 163: 1395-1404
18 Rubin GD, Dake MD, Napel SA. Three-dimensiomal spiral CT angiography of the abdomen: initial clinical experience.[J] Radiology 1993; 186: 147-152
19.Cho A, Okazumi S, Takayama W. Anatomy of the right anterosuperior area(segment 8) of the liver: evaluation with helical CT during arterial portography. [J]Radiology 2000; 214: 491-495
20 Soyer P, Roche A, Gad M. Preoperative segmental localization of hepatic metastases: utility of three-dimensional CT during arterial portography. Radiology[J]1991; 180: 653-658
21 Moran BJ, O'Rourke N, Plant GR et al. Computed tomographic portography in preoperative imaging of hepatic neoplasms.[J] Br J Surg. 1995; 82(5): 669-671.
22 吴东，周康荣，陈祖望．螺旋CT门静脉造影准直和成像方法的合理选择．[J] 临床放射学杂志，2000，19：40-43
23 刘学静，武乐斌，柳澄．多层螺旋CT门静脉造影术准直与螺距匹配及重建方法优化选择 中国医学影像技术 2004(20)12：1933-1936
24 Soyer P, Heath D, Bluemke DA et al. Three-dimensional helical CT of intrahepatic venous structures: comparison of three rendering techniques. [J]Comput Assist Tomogr. 1996; 20(1): 122-127.
25 Thomas G. Flohr, Stefan Schaller, Karl Stierstorfer, et al. Multi-Detector Row CT Systems and Image-Reconstruction Techniques.[J] Radiology 2005; 25(2): 756-773;
26 柳澄 秦维昌．多层螺旋CT(一)、(二)[J]医学影像学杂志，2000，10(3)：194-195；2001，11(1)：53-54
27 刘学静 武乐斌 柳澄 多层螺旋CT肝门静脉成像及其临床应用价值[J]中国临床解剖学杂志，2004，22(5)：478-480
28 杨建荣，云玉珍，张宝林 正常成人肝内静脉系的解剖及螺旋CT血管成像的对照研究[J]中国临床医学影像杂志．．2005；16(3)：167-169．
29 韩国宏，郭庆林．肝脏段的解剖基础及其变异研究进展[J]国外医学临床放射学分册1998；6：344-347
30 AG Heriot, ND Karanjia. A review of techniques for liver resection[J]Ann R Coll Surg Engl. 2002; 84: 371-380.
31．张大海，顾伟中．肝脏的功能解剖和CT定位[J]临床放射学杂志1999；18(6)：374-375．
32 皮执民，王心见．肝脏手术的历史回顾[J]中国现代手术学杂志．2003，7(2)：156-158．
33 严律南．肝脏外科新进展．[J]中华外科杂志；2004，12(1)：10-11．
34 Hjortsj CH. The topography of the intrahepatic duct system[J]. Acta Anat (Basel). 1951; 11: 599-615.
35 中国肝脏专家组．肝脏解剖和肝脏手术切除术统一名称[J]中华外科杂志．2002；40(5)：339-341．
36 David C. Madoff, MD; Marshall E. Hicks, MD; Jean-Nicolas Vauthey, MD; et al. Transhepatic Portal Vein Embolization: Anatomy, Indications, and Technical Considerations.[J] RadioGraphics 2002; 22(5): 1063-1076.
37 Deshpande RR, Heaton ND, Rela M. Surgical anatomy of segmental liver transplantation[J] Br J Surg. 2002; 89(9): 1078-88.
38 Goldsmith NA, Woodburne RT. The surgical anatomy pertaining to liver resection[J]. Surg Gynecol Obstet, 1957; 105: 310-318.
39 Bismuth H. Surgical anatomy and anatomical surgery[J]. World J Surg, 1982, 6: 3-9.
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