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目的探讨肝内肝动脉、肝静脉和胆道等管道系统的螺旋CT三维重建在囊性肝包虫病的应用研究及意义。方法8例囊性肝包虫病患者术前进行肝内管道包括肝动脉、肝静脉、门静脉及胆管螺旋CT造影扫描,多轴向投照容积重建法三维重建,观察分析三维重建图像中肝动脉、肝静脉、门静脉及胆管的主要分支显影、形态、分布、受压和移位情况,分别将肝包虫囊肿的空间位置关系,与“外膜内完整摘除术”中实际情况进行对照。结果肝脏螺旋CT三维重建图像清晰地显示病变与肝内管道的三维空间关系,包括管道的受压移位并与包虫囊肿呈半抱球状。部分肝门静脉、肝管左右支夹角增大,部分胆管壁嵌于包虫外囊壁内。8例“外膜内完整摘除术”均成功,术中证实三维图像与实际情况相符。结论利用CT三维重建技术,对囊性肝包虫进行术前的准确定位、对指导囊性肝包虫“外膜内完整摘除术”的操作具有重大指导意义。
Objective To investigate the application and significance of spiral CT three-dimensional reconstruction of intrahepatic hepatic artery, hepatic vein and biliary tract in cystic liver hydatid disease. Methods Eight patients with cystic echinococcosis were treated with intrahepatic ductography, including hepatic artery, hepatic vein, portal vein and bile duct spiral CT scan before operation. Three-dimensional reconstruction was performed by multi-axial projection volume reconstruction. The hepatic artery , Hepatic veins, portal veins and bile duct main branch of the development, morphology, distribution, compression and displacement, respectively, the space position of hydatid cysts, and “complete excision of the adventitia” in the actual situation of the control. Results Three-dimensional reconstruction images of liver spiral CT clearly show the three-dimensional relationship between the lesion and the intrahepatic pipelines, including the pressure displacement of the pipelines and the half embracing of the hydatid cyst. Part of the hepatic portal vein, left and right hepatic duct branch angle increases, part of the bile duct wall embedded in hydatid cysts. 8 cases of “complete excision of the adventitia” were successful, the operation confirmed that the three-dimensional images and the actual situation. Conclusion The accurate preoperative localization of cystic echinococcosis using CT three-dimensional reconstruction is of great guiding significance for guiding the operation of “complete enucleation of cystic echinococcosis.”