三维可视化技术在肝脏主要脉管空间构型与肝叶体积分布评估中的临床应用

Clinical application of three-dimensional visualization technology in assessing the spatial configuration of major hepatic vessels and liver lobar volume distribution

摘要:

背景与目的 肝脏脉管系统解剖变异复杂，且不同脉管之间存在高度个体化的空间关系，传统二维影像在整体构型识别和空间定量分析方面存在局限。本研究基于三维可视化技术，系统评估肝门区及肝内主要脉管的空间构型特征及其与肝叶体积分布的关系，探讨其在精准肝脏外科术前评估中的应用价值。方法 回顾性纳入上海交通大学医学院附属仁济医院610例活体肝移植供体及158例胆管扩张患者，基于增强CT数据构建肝动脉、门静脉、肝静脉及胆管的三维可视化模型。对门静脉分型、肝静脉解剖特征、胆管走行方式以及肝内外脉管的空间位置关系进行系统分析，并进一步比较不同构型下肝叶及区域体积分布的差异。结果 三维可视化技术能够清晰呈现肝门区及肝内脉管的立体走行及相互关系。门静脉不同拓扑分型患者的肝段及区域体积分布存在显著差异，其中右前支起源于左支的门静脉构型患者右后区体积占比明显增加。存在肝右后下静脉且直径≥5 mm者，其右后区体积占比亦显著高于其他患者。肝外空间关系分析显示，肝右动脉与门静脉、胆管之间存在相对稳定的空间分布模式；肝内分析进一步发现，右后肝管与门静脉右支的空间位置与肝右动脉走行方式具有显著相关性。结论 三维可视化技术可在术前准确识别肝脏脉管的变异类型及其复杂空间构型，揭示脉管解剖特征与肝叶体积分布之间的内在联系，为精准肝切除、活体肝移植及复杂肝胆外科手术的安全实施提供可靠的解剖学依据。

Abstract:

Background and Aims The hepatic vascular and biliary systems exhibit substantial anatomical variability and complex spatial relationships, posing challenges for precise surgical planning based on conventional two-dimensional imaging. This study aimed to evaluate the clinical value of three-dimensional visualization in characterizing the spatial architecture of hepatic vasculature and bile ducts and to explore its association with hepatic volumetric distribution.Methods A total of 610 living liver donors and 158 patients with bile duct dilatation were retrospectively analyzed. Three-dimensional models of the hepatic artery, portal vein, hepatic veins, and bile ducts were reconstructed from contrast-enhanced CT images. Vascular and biliary anatomical patterns, spatial relationships, and their correlations with hepatic lobe and segmental volumes were systematically assessed.Results Three-dimensional visualization enabled intuitive and comprehensive depiction of hepatic vascular and biliary anatomy. Distinct portal vein configurations were associated with significant differences in regional liver volume distribution, with an increased proportion of the right posterior lobe observed in patients with specific portal vein branching patterns. The presence of an inferior right hepatic vein with a diameter ≥5 mm was also associated with a larger right posterior lobe volume. Analyses of extrahepatic and intrahepatic spatial relationships revealed relatively consistent positional patterns between the right hepatic artery, portal vein, and bile ducts, and a significant correlation was observed between the spatial courses of the right hepatic artery and the right posterior bile duct.Conclusion Three-dimensional visualization provides accurate preoperative assessment of hepatic vascular and biliary anatomy and clarifies complex spatial relationships and their volumetric implications. This technique offers critical anatomical support for precision hepatobiliary surgery and liver transplantation.