三维计算机断层扫描在经肝前入路尾状叶切除术中的应用价值。

Usefulness of 3-dimensional computed tomography for caudate lobectomy by transhepatic anterior approach.

作者信息

Togo Shinji, Shizawa Ryoichi, Kanemura Eisyu, Tanaka Kuniya, Masunari Hideki, Endo Itaru, Sekido Hitoshi, Shimada Hiroshi

机构信息

Department of Surgery II, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.

出版信息

Hepatogastroenterology. 2002 Mar-Apr;49(44):461-6.

PMID:11995474

Abstract

BACKGROUND/AIMS: Improvement of precision and safety of resection of caudate lobe by the transhepatic anterior approach using preoperative 3-dimensional computed tomography.

METHODOLOGY

The 3D-computed tomography images of 32 patients who underwent hepatectomy for hepatocellular carcinoma and metastatic tumors were reviewed. The usefulness of 3D-computed tomography was assessed on the basis of its depiction of the portal branch distribution of the caudate lobe and of the position of the parenchymal division plane in the transhepatic anterior approach.

RESULTS

Number of portal vein branches in the caudate lobe: 1 to 5 (average, 2.75) portal vein branches were detected in the caudate lobe at the optimal angle (left-posterior 135 degrees) by 3D-computed tomography: P1l-sup in 84.3%, P1r-sup in 71.9%, P1r-inf in 71.9%, P1l-med in 15.6% and P1-trunk in 3.1%. 2). We classified the structure of the caudate lobe into four types, one type having two subtypes, based on the 3D-computed tomography findings of its portal branch distribution: Type 1: presence of 1rs, 1ri, 1ls; Type 2a: absence of 1ri; Type 2b: absence of 1rs; Type 3: absence of 1ls; Type 4: presence of 1t alone. Type 1 was observed in 16 of the 32 patients (50.0%), type 2a in 4 (12.5%), type 2b in 8 (25.0%), type 3 in 3 (9.4%) and type 4 in 1 (3.1%). 3) When the tributary of the right hepatic vein draining segment 5 (RV5) can be detected (type 1: 81.3%), the right surface of the middle hepatic vein should be exposed; whereas its left surface should be exposed when RV5 cannot be detected (types 2 and 3: 18.7%).

CONCLUSIONS

Preoperative 3D-computed tomography images enable more accurate diagnosis of intrahepatic tumor location and facilitate detection of the portal veins of the caudate lobe, thus simplifying both caudate lobectomy and the selection of which side of the division plane and of the middle hepatic vein to divide the liver parenchyma in the transhepatic anterior approach, and allowing complete preservation of the circulation of the remnant liver.

摘要

背景/目的：利用术前三维计算机断层扫描改善经肝前入路尾状叶切除的精准度和安全性。

方法

回顾了32例行肝细胞癌及转移瘤肝切除术患者的三维计算机断层扫描图像。基于其对尾状叶门静脉分支分布及经肝前入路实质分割平面位置的显示情况，评估三维计算机断层扫描的实用性。

结果

1）尾状叶门静脉分支数量：在最佳角度（左后135度）通过三维计算机断层扫描在尾状叶检测到1至5支（平均2.75支）门静脉分支：左后上支（P1l-sup）占84.3%，右后上支（P1r-sup）占71.9%，右后下支（P1r-inf）占71.9%，左中支（P1l-med）占15.6%，主干支（P1-trunk）占3.1%。2）根据三维计算机断层扫描门静脉分支分布结果，将尾状叶结构分为四种类型，其中一种类型有两个亚型：1型：存在右后上支（1rs）、右后下支（1ri）、左后上支（1ls）；2a型：无右后下支（1ri）；2b型：无右后上支（1rs）；3型：无左后上支（1ls）；4型：仅存在主干支（1t）。32例患者中，1型16例（50.0%），2a型4例（12.5%），2b型8例（25.0%），3型3例（9.4%），4型1例（3.1%）。3）当能检测到引流5段的右肝静脉分支（RV5）时（1型：81.3%），应暴露肝中静脉右表面；当无法检测到RV5时（2型和3型：18.7%），应暴露肝中静脉左表面。