临床肝胆病杂志2025，Vol.41Issue(10)：2118-2124,7.DOI:10.12449/JCH251023
基于Laennec膜的肝蒂CT三维重建及肝蒂鞘外分离阻闭钳的研发与验证
Three-dimensional CT reconstruction of the hepatic pedicle based on the Laennec's capsule and the development and validation of extra-sheath dissection/occlusion clamp
摘要
Abstract
Objective To investigate the anatomical features of three-dimensional(3D)reconstruction of the hepatic pedicle based on the Laennec's capsule,as well as its application value in the development of extra-sheath dissection/occlusion clamp and precise hepatectomy.Methods A retrospective analysis was performed for the abdominal contrast-enhanced CT data of 100 patients without anatomical abnormalities of the hepatic pedicle in The General Hospital of Western Theater Command from January 2021 to June 2024.The Hisense CAS system combined with the 3D U-net deep learning algorithm was used for 3D reconstruction of the hepatic pedicle at the level of Laennec's capsule,and the hepatic pedicle was measured in terms of the length,outer diameter,and angle of the main trunk and branches.An extra-sheath hepatic pedicle dissection/occlusion clamp was developed based on the above measurements,and a total of 30 patients scheduled for right hemihepatectomy were enrolled and randomly divided into device group and control group,with 15 patients in each group.The two groups were compared in terms of hepatic pedicle handling time,time of operation,intraoperative blood loss,and the incidence rate of bile duct injury.The independent-samples t test was used for comparison of continuous data between two groups,and the Fisher's exact test was used for comparison of categorical data between two groups.Results The results of 3D reconstruction revealed four variants in the main trunk branches of the hepatic pedicle,with type Ⅰ(left-right branching)accounting for 88%(88/100),type Ⅱ(trifurcation type)accounting for 5%(5/100),type Ⅲ(right anterior branching)accounting for 5%(5/100),and type Ⅳ(special type)accounting for 2%(2/100).The outer diameter of the main hepatic pedicle was 24.10±6.16 mm,the length of the left main branch was 20.59±6.38 mm,and the length of the right main branch was 21.99±7.98 mm.Compared with the control group,the device group had significantly shorter hepatic pedicle handling time(14.10±1.30 minutes vs 17.50±2.00 minutes,t=-5.620,P=0.001)and time of operation(217.00±28.28 minutes vs 241.87±19.49 minutes,t=-2.804,P=0.009).The device group had a significantly lower incidence rate of bile duct injury than the control group(0 vs 20%,P=0.031).Conclusion 3D reconstruction based on the Laennec's capsule can accurately display the anatomical variations of the hepatic pedicle.The extra-sheath hepatic pedicle dissection/occlusion clamp developed based on such data can optimize the process of hepatic pedicle management and improve surgical safety,and therefore,it holds promise for clinical application.关键词
消化系统外科手术/成像,三维/Laennec膜/外科器械Key words
Digestive System Surgical Procedures/Imaging,Three-Dimensional/Laennec's Membrane/Surgical Instruments引用本文复制引用
林治宇,夏鑫,雷寰,罗豫川,程龙,梁鸿寅,汪涛..基于Laennec膜的肝蒂CT三维重建及肝蒂鞘外分离阻闭钳的研发与验证[J].临床肝胆病杂志,2025,41(10):2118-2124,7.基金项目
中国人民解放军西部战区总医院院管项目(41C4168C) The General Hospital of Western Theater Command Management Project(41C4168C) （41C4168C）
