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右肝切除术后供体门静脉血流动力学变化的模拟

Simulation of portal hemodynamic changes in a donor after right hepatectomy.

作者信息

Ho Cheng-Maw, Lin Reui-Kuo, Tsai Shun-Feng, Hu Rey-Hen, Liang Po-Chin, Sheu Tony Wen-Hann, Lee Po-Huang

机构信息

Department of Surgery, National Taiwan University Hospital, Taipei, 100 Taiwan, R.O.C.

出版信息

J Biomech Eng. 2010 Apr;132(4):041002. doi: 10.1115/1.4000957.

Abstract

Remnant livers will be regenerated in live donors after a large volume resection for transplantation. How the structures and hemodynamics of portal vein will evolve with liver regeneration remains unknown. This prompts the present hemodynamic simulation for a 25 year-old man who received a right donor lobectomy. According to the magnetic resonance imaging/computed tomography images taken prior to the operation and one month after the operation, three sequential models of portal veins (pre-op, immediately after the operation, and one-month post-op) were constructed by AMIRA and HYPERMESH, while the immediately after the operation model was generated by removing the right branch in the pre-op model. Hemodynamic equations were solved subject to the sonographically measured inlet velocity. The simulated branch velocities were compared with the measured ones. The predicted overall pressure in the portal vein after resection was found to increase to a magnitude that has not reached to an extent possibly leading to portal hypertension. As expected, blood pressure has a large change only in the vicinity of the resection region. The branches grew considerably different from the original one as the liver is regenerated. Results provide useful evidence to justify the current computer simulation.

摘要

活体供体在进行大面积肝切除用于移植后,残余肝脏会再生。门静脉的结构和血流动力学将如何随肝脏再生而演变仍不清楚。这促使对一名接受右半肝供体肝叶切除术的25岁男性进行当前的血流动力学模拟。根据术前和术后一个月拍摄的磁共振成像/计算机断层扫描图像,利用AMIRA和HYPERMESH构建了门静脉的三个连续模型(术前、术后即刻和术后一个月),而术后即刻模型是通过在术前模型中去除右分支生成的。根据超声测量的入口速度求解血流动力学方程。将模拟的分支速度与测量值进行比较。发现切除后门静脉的预测总压力增加到尚未达到可能导致门静脉高压程度的水平。正如预期的那样,血压仅在切除区域附近有较大变化。随着肝脏再生,分支与原来的分支有很大不同。结果为当前的计算机模拟提供了有用的证据。

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