- 期刊
多切面電腦斷層肝臟動態掃描之3D影像體積對活體捐贈術前評估
The Dynamic Study on Preoperative Evaluation of Living Donor Transplantation by 3D Reformation Images of the Liver MDCT
摘要
活體肝臟移植手術前捐贈的體積評估，主要仰賴電腦斷層（Computed Tomography, CT）檢查，以及電腦斷層影像後製重組的3D 影像，然而影像工作站3D 影像術前計算捐贈者肝臟體積，與外科實際開刀取出捐贈者肝臟體積會有些差異。所以本研究共收錄60 位自願之活體肝臟捐贈者，術前皆已接受PHILIPS iCT 256 多切面CT 肝臟動態掃描。檢查完成後使用影像重組工作站AZE（3.4）進行3D 影像的繪製與評估，其中包括肝臟之總體積，肝動脈、門靜脈、肝靜脈之血管解剖圖，再以血管之分佈圖進行肝臟左右葉切割。如此可以分別計算出總肝臟體積及模擬切割左右葉個別體積等之數據，藉由與外科肝臟移植小組實際開刀取出之捐贈肝臟體積數據，進行比較性之統計分析與討論。電腦斷層影像經3D 重組計算肝臟體積與外科醫師執行捐肝手術後紀錄之實際體積比較，相差低於50 cc 者占56.67%，相差介於50~100 cc 者占33.33%，其他因素造成相差過大者占10%。之後，線性迴歸統計分析結果顯示R^2值各為0.9433、0.7247、0.1849 等。因此掃描技術與3D 影像重組，能夠大大提高外科醫師對於活體肝臟捐贈者術前肝臟體積評估的準確度，幫助先天異常血管的銜接，進而確保捐贈者與受贈者安全。
並列摘要
The volume of liver is mainly evaluated by computed tomography (CT) before living donor transplantation. However there is still considerable difference between the hepatic volume calculated by CT workstation and the real volume measured after surgically removed. Total 60 volunteer donors who had completed preoperative dynamic multi-detector CT scan for liver (Philips iCT 256) and 3D reconstruction (Workstation: AZE 3.4) for living donor evaluation were recruited. The 3D reconstruction was focused on total liver volume and the vascular anatomy of hepatic artery, portal vein and hepatic vein. Subsequently the right and left lobes were divided according to the vascular anatomy and the volume of each lobe were calculated. The estimated volume would be compared with the real hepatic volume after surgical removal. The difference between the estimated hepatic volume and the real volume were less than 50 mL in 56.67% of the patients, 50 to 100 mL in 33.33%, and more than 100 mL in 10%, with the R2 value under linear regression analysis 0.9433, 0.7247 and 0.1849 respectively.In conclusion, 3D reconstruction of dynamic CT scan can demonstrate the vascular anatomy of liver and thus helpful for guiding the vascular anastomosis during surgery. By dividing the right and left lobes according to the vascular anatomy, the estimated hepatic volume would be more precise as compared with the real hepatic volume.
延伸閱讀
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