Clinic Application Of Digital Medical Technology In The Diagnosis And Treatment Of Blunt Liver Trauma

Research backgroundAnatomy is the basis of traditional liver segmentation method, according to the appearance of the liver segmentation, on the surface of the diaphragm, the falciform ligament divided liver into two leaf left and right, this is very different from the function of the left, right or left and right half liver. In the traditional segmentation method in liver leaf belongs to the right lobe of the liver, a portion of the left lobe function belongs to. Don’t show the subsection within blood vessels and bile duct structure, the advantages of the method is relatively straightforward, but not practical. In 1957 the Couinaud C Glisson system in the intrahepatic distribution based Couinaud segmentation method, the liver will be divided into left and right half liver, five leaf and eight segments. And gradually popular in Asia and Europe, according to the functional anatomy of the liver can be divided into eight independent segment, the segment method to hepatic fissure and portal vein and hepatic vein distribution in the liver, on the basis of right hepatic vein to the liver is divided into right front and right rear, Middle hepatic vein in the liver can be divided into the left lobe and right lobe (or right and left half liver) from the inferior vena cava to the gallbladder fossa through this surface, The left hepatic vein and the left lobe of the liver is divided into medial and lateral segment.Portal vein to the liver is divided into upper and lower section, left and right branch of portal vein from upper and lower, respectively, in each section of the center of the caudate lobe is both a leaf and a segment. Each liver segment use Roman numerals Ⅰ-Ⅷ tags, I:Caudate lobe; II:Left lateral lobe on;Ⅲ:The left lateral segment; Ⅳ:Left inside leaf (Bismuth classification 4th section is divided into 4 a and 4 b); V:Front right inferior segment; Ⅵ:Right posterior lobe of the lower segment; Ⅶ:right after the leaf segment; Ⅷ:the right anterior superior, segment number according to clockwise, The Couinaud segmentation method in a clockwise direction paragraphs numbered, its advantage is that each is a separate unit, remove any piece without affecting the other. In order to guarantee the liver, remove must be conducted along these segmented surrounding blood vessels, the removal of the line parallel to the hepatic vein, it is located in the center position of the portal vein, bile duct and hepatic artery were preserved. The segmentation method is practical, each liver segment is independent of the inflows and outflows blood vessels and bile duct system. At the center of the each paragraph has the branch of portal vein, hepatic artery and bile duct, the periphery of the each segment have flowed through hepatic vein, for CT imaging diagnosis, surgery, Has a practical significance and wide application. Bismuth’s segment method similar to the Couinaud points method, the difference between is very small, very popular in the North American States.Bismuth three hepatic veins to the liver is divided into four quadrants, and then continue segmented. These fan-shaped area is bounded to the portal vein, intravenous supply of each area by a portal vein. The separation between regions is usually the hepatic vein. Hepatic vein and portal vein are intertwined, like the fingers of two hands. The left portal vein to the liver is divided into two fan zones:Former part and back part, left anterior sector has two segments:segment 4 (which is the Side lobe of liver) and 3 (The front part of the left lobe anatomy). These two split liver or umbilical fissure separated from left, the left after the sector is only a two-segment, located in the left lobe of the rear. The current international use of Couinaud liver segments division method. The recent reported that variation of intrahepatic duct Couinaud liver segment cannot reflect the liver internal anatomy, resulting in imaging location error and the effect of formulation, liver operation plan implementation.Traditional segmentation method is on the body specimens of liver perfusion after casting were studied, obtained anatomical information is limited, the clinician is difficult to form a three-dimensional and space in your mind. Anatomy is not clear, lead to the complication of surgery, decision-making difficulties, the risk is bigger., application of CT/MRI two-dimensional imaging technology has changed the shortcomings of one-dimensional flat overlapping image, but in solving the continuity, dynamic display image is still not satisfactory. With the development of technique of multi-slice spiral CT acquisition and the establishment of Chinese digitized virtual human data set, a variety of domestic and foreign 3D medical software have been produced,3D reconstruction can reproduce the human skeleton, vascular, visceral, anatomy and tumor location, spatial dynamic observation. However, most foreign 3D medical software is expensive, not in any region of interest in color, transparency, zoom, were not arbitrary, and do not have the simulation operation apparatus, simulation of three-dimensional operation cannot, limits its wide application.In the national high technology research and development program (863 Program) project; the National Natural Science Foundation of China; in Guangdong Province Natural Science Team Project; Guangdong Province and Ministry of education combined with production; Chinese Academy of Sciences comprehensive strategic cooperation projects in Guangdong Province and other scientific research project support, we use 3D medical image visualization system of independent research and development (Medical Image Three Dimensional Visualization System, MI-3DVS), based on more than 64 layers of spiral CT image information data sub-millimeter,3D reconstruction and rapid, accurate thin-layer CT images data of 100 cases of human normal liver alive, according to the intrahepatic portal vein and hepatic vein variation and its distribution, individual of liver segmentation, classification, and the individual segmentation method is applied to the virtual software platform simulation hepatectomy, determination of residual liver volume, the study makes on the liver, intrahepatic vasculature variation accurate assessment of resectability possible, not only reduces the blood out of, but also preservation of the liver parenchyma more, incidence and mortality of patients to reduce the complication after liver resection. Patients can choose the best plan of operation before operation, practical operation, to achieve the true digital liver surgery. At the same time, based on the advantage of 17 cases patients with blunt liver trauma reconstruction of data on the MI-3DVS system in the diagnosis and treatment of blunt liver trauma.part I Liver 3D reconstruction technology under the guidance of the individual liver segmentsObjectiveResearch MI-3DVS individualized reconstruction imaging characteristic of liver;The normal and anomalous features of 100 cases of live human normal liver the hepatic portal vein, on the basis of segmentation of individual variation of portal vein of liver;The normal and anomalous feature of hepatic vein of the above 100 cases of live human normal liver, based on the segmentation of liver individual variation of hepatic vein; To investigate the significance of individual liver segment.MethodsThe research object and materials:on January 1,2013 to January 1,2015, about 100 healthy volunteers underwent CT scanning of the upper abdomen examination of 64 rows of CT abdominal plain and enhanced scanning,63 men,37 women, mean age of 25 years (all volunteers signed informed consent, approved by the Southern Medical University ethics committee, in accordance with the medical care routine operation). Liver function is normal, liver without implement qualitative sex pathological change. Exclusion criteria:1 hepatic artery, portal vein, hepatic vein and inferior vena cava stenosis or occlusion of portal vein; 2, hepatic vein, inferior vena cava developing disabilities; 3 have X-ray examination of radiography agent allergy, contraindications.CT data collection and research equipment, imaging scanning parameters, medicine image 3D reconstruction method, data collection methods and individual segments with reference to Chi-Hua Fang published literature describes the three-dimensional box, When the portal vein is normal, we according to the hepatic vein type variation of liver of individual segments, when hepatic vein is normal, we according to the portal vein type variation for individual segments, segment are named according to clockwise naming, for this issue was not found in the variation of the portal vein and the hepatic vein variation type, or portal vein and hepatic vein were mutated and the data we do not for individual types of objects.Statistical methods:This study is the morphological description, does not involve statistical inference.Results1. Digitization portal vein display statistics.Three-dimensional reconstruction of the portal vein model structure is clear, realistic, three-dimensional sense. Hepatic portal vein was 100%, in accordance with the method of the the Couinaud portal vein 0-2 level branch of the portal vein model divided 100 healthy volunteers for the following types:normal:punishment to the left branch and the right branch of the portal vein and in the hepatic portal, right branch to go to the right, into the right anterior and right posterior branch,82 cases, accounting for 82%; type I variation:the portal vein at the hepatic hilum was trigeminal like, directly into the left branch of the right anterior and right posterior branch,14 cases, accounting for 14%. Type II variation:right anterior portal vein and the left portal vein dry in 4 cases, accounting for 4%.Right portal vein was not found in the literature reported missing, such as the left portal vein horizontal segment of the absence of phenotypic variation.2. Digital hepatic vein display statistics.Hepatic vein reconstruction model is clear and distinct, stereo sense is strong, left, middle and right hepatic vein display at a rate of 100%. Hepatic vein classification method with reference to the pre-project Fang Chi China study concluded that overall classification is as follows:100 healthy volunteers hepatic vein type A (left, middle and right three hepatic veins into the inferior vena cava):41.0% (41/100), B (Left hepatic vein (LHV) and the middle hepatic vein (MHV) in the synthesis of short after working into the inferior vena cava),59.0%(59/100), C (right hepatic vein (RHV) and middle hepatic vein synthetic staple dry and then into the inferior vena cava) not found in this study. Right hepatic vein typing:A type (this type is the most common, a trunk and a number of small branches):78.0%(78/100), Type B (right hepatic vein is a short stem, with thick liver vein from compensatory role):14.0%(14/100), C (small right hepatic vein associated with a coarse directly into the inferior vena cava, right after the vein (IRHV)):4.0%(4/100) D-type (small right hepatic vein with a small directly into the inferior vena cava, right hepatic vein (ARHV)):4.0%(4/100). Right hepatic vein subtypes:MAIN OUTCOME right hepatic vein whether the roots as a start number of branches and branch:type 134.0% (34/100):right hepatic vein in the early roots of large branches, only one trunk injection vena cava, type Ⅱ 56.0%(56/100):right hepatic vein as a backbone, and divided into two thickness differences in the early small branches of type Ⅲ 6.0% (6/100):right hepatic vein inferior vena cava roots of divided into two thickness little difference branches of type IV 8.0%(8/100):right hepatic vein inferior vena cava divided into two thickness little difference branches at the base, one is a branch and then divided into two thickness is insignificant branch. Hepatic vein typing:A type 78.0%(78/100):This is the most common type, hepatic vein only one trunk and branch; B-20.0%(20/100):into the common hepatic vein the segment IV vein (Sg4V,); type C:IV paragraph vein and umbilical vein import hepatic vein (C type not found in this study); D-type,12.0%(12/100):there directly into the inferior vena the vein segment Ⅳ vein. The left hepatic vein typing:A type 82.0%(82/100):This type is the most common, only one is left hepatic vein trunk and small branches; B-18.0%(18/100):the emergence of the import of the left hepatic vein paragraph 4 of the vein; C type:import IV segment of the left hepatic vein vein and umbilical vein (C type not found in this study).3.digital individual liver segment statistics.Portal vein of normal liver individual is divided into 8 segments and Couinaud segments of same type of individual variation, the liver is divided into 7 sections, type II variant hepatic individual is divided into 9 sections. Hepatic vein of normal liver individual is divided into 8 segments and Couinaud segments, with 4 segments of hepatic vein in liver of individual is divided into 9 sections,8 sections of the liver with hepatic vein individual was divided into 9 segments, with 4 segments and 8 segments of the hepatic veins of liver individual is divided into 10 sections, with the right lower posterior vein the liver of individual is divided into 9 sections.ConclusionsBased on 64-slice spiral CT hepatic vein enhanced scan datasets, using MI-3DVS digitized three-dimensional reconstruction of speed, the effect is good, the hepatic portal vein, hepatic vein model clear, realistic, three-dimensional sense of strong, needed rotate freely transparent operation; in individual liver Break, surgical risk assessment, the choice of surgical approach, and a great value in clinical teaching.The image data of the 3D model from the living human body, true representation of the liver and intrahepatic vascular in the body of the original anatomical location between truly living human anatomy digitized and disease diagnosis procedures;part II Clinic application of the 3D reconstruction in the diagnosis and treatment of blunt liver traumaObjectiveUsing MI-3DVS system reconstruction of 17 cases of blunt liver trauma patients, observation of three-dimensional imaging features of hepatic trauma;3D reconstruction can prove that the efficacy of conservative patients with conservative treatment;Patients need operation, intraoperative and preoperative 3D reconstruction of control, prove that the MI-3DVS system can clear the site of injury, hematoma, vascular injury before operation, can help physicians decide operation way, operation size, advantages of three-dimensional reconstruction in the diagnosis and treatment of liver trauma.MethodsResearch objects and materials:(1) collect the Digital Medical Center from January 2009 to January 2015 a total of 17 patients (14 males,3 females; average age, 29 years old) liver injury in patients with liver 64-slice spiral CT scan data (All volunteers signed informed consent and approval of the Southern Medical University Ethics Committee, in line with the operating practices of medical care). (2) computer systems and software configuration with the first chapterImaging scan parameters, data acquisition, medicines, image reconstruction method with the first chapter.Observing the liver major blood vessels within the hepatic artery, hepatic vein, portal vein injury data.Statistical Methods:In this study, morphological description does not involve statistical inference.Results17 cases of traumatic patients were blunt abdominal liver injury.14 cases of patients with preoperative three-dimensional reconstruction model showed the intrahepatic vascular injury, need operation treatment accordingly, was found in the corresponding three-dimensional reconstruction and preoperative conditions.3 cases of preoperative three-dimensional reconstruction model did not show the intrahepatic vascular injury, conservative treatment for patients with successful. All 17 patients recovered and were discharged from hospital.ConclusionsAbdominal medical image visualization system (MI-3DVS) 3D data can be rapid and efficient completion of the liver of 64 row spiral CT program segmentation,3D reconstruction,3D image completed can damage a good reflection of the liver, it makes patients in preoperative liver rupture has a more comprehensive understanding and diagnosis, make the operation more precise, so that patients receive timely treatment correctly, abdominal medical image system has a good applied future in the diagnosis and treatment of blunt liver trauma.