Kamiyama Toshiya, Nakagawa Takahito, Nakanishi Kazuaki, Kamachi Hirofumi, Onodera Yuya, Matsushita Michiaki, Todo Satoru
Department of General Surgery, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku Sapporo, 060-8638, Japan.
World J Surg. 2006 Mar;30(3):400-9. doi: 10.1007/s00268-005-0383-4.
Hepatectomy is particularly difficult when the tumor is large, close to the inferior vena cava or the main trunk of the hepatic or portal vein, or in the caudate lobe, as well as when the operation is a re-hepatectomy, because two-dimensional computed tomography (CT) often does not clearly show tumor location relative to blood vessels.
To evaluate the efficacy of three-dimensional computed tomography (3D-CT), reconstructed from multidetector-row computed tomography (MD-CT) with contrast, MD-CT was performed in 17 patients before hepatectomy.
The third-order branches of the hepatic artery and the portal vein were clearly shown in all cases. Both the hepatic vein, which drained the same segment that the portal vein fed, and the portal vein were also clearly shown. These vessels could be visualized from any perspective. In 2 patients who underwent hemihepatectomy, large tumors (23.0 and 17.0 cm) displaced the vasculature, but the positions of tumor and vessels could be precisely evaluated by 3D-CT. In patients who required replacement of the vena cava with synthetic grafts, the distance and direction of pressure to IVC by tumor was accurately estimated by 3D-CT. In patients who were limited to segmentectomy or partial hepatectomy because of prior hepatectomy or tumor position, evaluation of the glissons was facilitated by 3D-CT.
Three-dimensional-CT was extremely useful for preoperative simulation because it provided important information that could not be obtained with 2D-CT.
当肿瘤体积较大、靠近下腔静脉或肝静脉或门静脉主干、位于尾状叶时，以及进行再次肝切除手术时，肝切除术会特别困难，因为二维计算机断层扫描（CT）通常无法清晰显示肿瘤相对于血管的位置。
为了评估由多排探测器计算机断层扫描（MD-CT）增强扫描重建的三维计算机断层扫描（3D-CT）的效果，在17例患者肝切除术前进行了MD-CT检查。
所有病例中肝动脉和门静脉的三级分支均清晰显示。引流门静脉供血相同节段的肝静脉以及门静脉也清晰显示。这些血管可以从任何角度观察。在2例行半肝切除术的患者中，巨大肿瘤（分别为23.0 cm和17.0 cm）使血管移位，但通过3D-CT可以精确评估肿瘤和血管的位置。对于需要用人造血管置换下腔静脉的患者，3D-CT能够准确估计肿瘤对下腔静脉的压迫距离和方向。对于因既往肝切除术或肿瘤位置而只能行节段切除或部分肝切除术的患者，3D-CT有助于评估肝蒂。
三维CT对术前模拟极为有用，因为它提供了二维CT无法获得的重要信息。
