| Objective: To reconstruct the three-dimensionally enhanced CT image of the patient’s liver through the Hisense Computer-Assisted Surgery System(Hisense CAS),analyze the types of portal vein branches and divide the liver segments according to Dong’s liver segmentation,and determine the shape and boundaries of the liver segments.Explore the anatomical rationality of Dong’s liver segmentation through research and Couinaud liver segment.Methods: The enhanced CT images of human livers of different ages that meet the inclusion criteria were collected,and the two-dimensional images were used to reconstruct the liver and portal vein through Hisense CAS.According to the Dong’s liver classification principle,the portal vein branching was analyzed,and the liver was performed through the simulated operation system.The segments are divided and marked with different colors,and the shape and boundary of the liver segment are compared with the Couinaud liver segment.Results: Hisense CAS can clearly and accurately restore the liver shape and the progression of portal vein branches。Among the 1575 patients,the portal vein of 676 patients was divided into 8 segments,which were classified as type A,accounting for 42.92%,and the course was basically the same as the Couinaud segment;The portal vein of 569 patients was divided into 9 segments,which were classified as type B,accounting for 36.13%.Unlike the Couinaud segment,the four-level portal vein vessels from the right anterior branch of the portal vein were divided into three branches,namely the caudal branch,the head-dorsal branch and the head-The ventral branches dominate segments Ⅴ,Ⅷ,and Ⅸrespectively,and the other branches of the portal vein run in the same way as type A;The right branch of the portal vein in 125 patients presented an arch-shaped main trunk.From the root to the tail,5-11 branches of the portal vein were used to control the rear of the right liver lobe,which was classified as type C,accounting for 7.94%.Among them,the right anterior branch of 72 cases branched out after the tertiary branch.Two main branches dominate the anterior segments V and Ⅷ of the right liver lobe,similar to type A,and are classified as C-a type.In 53 cases,the right anterior branch is divided into three main branches after the tertiary branch and dominates the anterior segments V,VIII,and IX of the right liver lobe,those similar to type B are classified as type C-b;205 patients with portal vein branch have a large variation,which is classified as type D,accounting for 12.70%.The portal vein branch of this type of patients is very different from Couinaud’s segment,mainly due to the variation of the right anterior branch,such as the right anterior branch from the left trunk of the portal vein,The right anterior branch is quadrant,and the right anterior branch is multi-branched.The dividing line between each liver segment is an irregular curve,which is completely different from the straight line of Couinaud’s liver segment.Conclusion: The course of portal vein in most patients is not consistent with the course proposed by Couinaud segmentation,and there are variations in position and branching mode;The dividing line of each liver segment is an irregular curve,which is also inconsistent with the straight line proposed by Couinaud’s segment.Dong’s liver segmentation can explain the type of portal vein branch variation.Therefore,we believe that,compared with Couinaud’s liver segmentation,Dong’s liver segmentation has more real,comprehensive,and scientific advantages,and has more precise and effective guiding significance in clinical research and surgical guidance.Objective: The three-dimensional reconstruction of liver-enhanced CT images of patients with liver tumors was performed by Hisense CAS to obtain a three-dimensional liver model.Based on Dong’s liver segmentation,the portal vein branching,the position of the tumor and the positional relationship between the tumor and the surrounding vessels were analyzed,and the Dong’s liver segmentation was studied.Clinical applicability.Methods: A collection of 144 patients undergoing hepatectomy for liver tumors in the Department of Hepatobiliary and Pancreatic Surgery of Qingdao University Hospital from 2018 to 2020,including 109 cases of hepatocellular carcinoma,19 cases of cholangiocarcinoma,2 cases of Focal Nodular Hyperplasia(FNH),and hepatic hemangioma 3 cases,5 cases of Colon adenocarcinoma liver metastasis,6 cases of other tumors.The portal vein branch analysis of the three-dimensional reconstruction model of the liver was carried out through Hisense CAS,which proved the comprehensiveness of Dong’s liver segmentation,and the clinical practicability of Dong’s liver segmentation was proved through precision surgery in typical cases.Results: Among the 144 patients,55 were in line with Dong’s liver classification type A,accounting for 38.19%;52 cases were in line with type B,accounting for 36.11%;14 cases were in line with type C(5 cases were type C-a,9 cases were type C-b),accounting for 38.19% 9.72%;23 cases conformed to type D,accounting for 15.97%.It is consistent with the big data statistics of Dong’s liver segmentation.According to the results of the threedimensional reconstruction,the position of the tumor in 114 patients was consistent with the position shown on two-dimensional CT,and the position of the tumor in 30 patients was not consistent with that shown on two-dimensional CT.Two-dimensional CT of 8 patients showed that the tumor was close to the second hepatic hilum and could not be treated by laparoscopic surgery.After simulated surgery through the computer-assisted surgery system,it was found that there was still room for operation between the tumor and the hepatic vein,and laparoscopic treatment was feasible.All patients underwent the operation according to the surgical plan made by the simulated operation system.The operation went smoothly.No serious complications occurred after the operation.All patients recovered and were discharged from the hospital.Conclusions: Dong’s liver segmentation basically covers different types of portal vein branch variants in clinical patients,combined with a computer-assisted surgery system,has practical and guiding significance in Precise hepatectomy。... |
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