CT门静脉三维重建在肝门部胆管癌手术中的临床应用

肝脏 ›› 2024, Vol. 29 ›› Issue (11): 1342-1345.

CT门静脉三维重建在肝门部胆管癌手术中的临床应用

刘尚大, 何海涛, 周鹏程

223001 江苏淮安八十二医院影像科(刘尚大,周鹏程);东部战区总医院影像科(何海涛)

收稿日期:2024-01-30 出版日期:2024-11-30 发布日期:2025-01-10
基金资助:
江苏省自然科学基金项目(BK20201492)

The clinical application of CT portal vein three-dimensional reconstruction in the surgery of hilarcholangiocarcinoma

LIU Shang-da¹, HE Hai-tao², ZHOU Peng-cheng¹

1. Department of Imaging, Huai’an 82nd Hospital, Jiangsu 223001, China;
2. Department of Imaging, the Eastern Theater Command General Hospital, Huai’an, 210018, China

Received:2024-01-30 Online:2024-11-30 Published:2025-01-10

摘要/Abstract

摘要： 目的探讨CT门静脉三维重建在肝门部胆管癌手术中的临床价值。方法 2017年8月至2022年8月淮安八十二医院诊治的肝门部胆管癌患者68例,行常规CT检查38例,行CT门静脉三维重建30例。比较常规CT、CT门静脉三维重建的Bismuth-Corlette分型结果、手术情况、肝脏体积。结果常规CT术前影像评估对Ⅰ型的诊断结果与术后病理学检查结果一致,对Ⅱ型、Ⅲa型、Ⅲb型、Ⅳ型的诊断结果与术后病理学检查结果不一致;CT三维重建术前影像评估对Ⅰ型、Ⅱ型、Ⅲa型的诊断结果与术后病理学检查结果一致,对Ⅲb型、Ⅳ型的诊断结果与术后病理学检查结果不一致。CT门静脉三维重建的术中出血量(524.3±16.8)mL、手术时间(4.8±1.2)h、住院时间(13.3±2.0)d、术后拔管时间(9.6±1.8)d,均低于常规CT的(679.1±17.3)mL、(6.3±1.5)h、(16.4±2.2)d、(11.4±1.9)d,差异有统计学意义(P<0.05)。两组并发症发生率及肝切除体积、肝脏总体积、剩余肝体积百分比,差异无统计学意义(P>0.05)。结论 CT门静脉三维重建应用于肝门部胆管癌手术,不仅有助于评估Bismuth-Corlette分型,还可减少术中出血、优化手术指标。

关键词: CT三维重建, 肝门部胆管癌, 手术应用

Abstract: Objective To explore the clinical value of CT portal vein three-dimensional reconstruction in the surgery of hilarcholangiocarcinoma (HCCA). Methods Between August 2017 and August 2022, 68 HCCA patients were collected and underwent routine CT examination (N=38 cases) or 3D reconstruction of the portal vein (N=30 cases). The Bismuth Colette typing results, surgical conditions, and liver volume were compared between the routine CT and CT portal vein three-dimensional reconstruction. Results The diagnostic results of conventional CT preoperative imaging evaluation for type I HCCA are consistent, whereas the diagnostic results for type II, IIIa, IIIb, and IV HCCA are inconsistent with that of the postoperative pathological examination; The diagnostic results of pre-operative CT three-dimensional reconstruction imaging for types I, II, and IIIa were consistent, whereas the diagnostic results for types IIIb and IV were inconsistent with those of postoperative pathological examination. The intraoperative bleeding volume, surgical time, hospital stay, and postoperative extubation time of CT portal vein three-dimensional reconstruction were (524.3 ± 16.8) mL, (4.8 ± 1.2) h, (13.3 ± 2.0) d, and (9.6 ± 1.8) d, respectively, which were less/shorter than those of [(679.1 ± 17.3) mL, (6.3 ± 1.5) h, (16.4 ± 2.2) d, and (11.4 ± 1.9) d by conventional CT (All P<0.05). There was no statistically significant difference in the incidence of complications, liver resection volume, total liver volume, and percentage of remaining liver volume between the two groups (P>0.05). Conclusion The application of CT portal vein 3D reconstruction in the surgery of HCCA is not only conductive to evaluating Bismuth Colette classification, but also to reducing intraoperative bleeding and optimizing surgical indicators, which has certain clinical guidance significance.

Key words: CT three-dimensional reconstruction, Hilarcholangiocarcinoma, Surgical application

刘尚大, 何海涛, 周鹏程. CT门静脉三维重建在肝门部胆管癌手术中的临床应用[J]. 肝脏, 2024, 29(11): 1342-1345.

LIU Shang-da, HE Hai-tao, ZHOU Peng-cheng. The clinical application of CT portal vein three-dimensional reconstruction in the surgery of hilarcholangiocarcinoma[J]. Chinese Hepatolgy, 2024, 29(11): 1342-1345.

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