基于Hisense CAS的肝左静脉分型及其对儿童左外叶肝移植流出道重建的临床意义

Based on Hisense CAS Constructing a Left Hepatic Vein Classification and Applying in Left Lateral Lobe Liver Transplantation in Children

摘要: 目的：利用海信计算机辅助手术系统(Hisense CAS)重建并分析肝左静脉分支的走行及变异等，并测定其相应的回流体积，提出新的肝左静脉分型方式，并探究其在人群中的分布情况、探讨其分型在儿童左外叶肝移植手术的流出道重建中的价值。方法：收集2021年1月1日至2021年12月31日于青岛大学附属医院行上腹部增强CT检查的患者的原始影像数据，纳入患者162例(研究对象1)，以及2019年1月1日至 2022年12月31日于青岛大学附属医院器官移植中心行左外叶肝移植手术的患儿及其供肝者的临床资料，纳入患者17对(研究对象2)。运用Hisens CAS技术对肝脏及其内部血管进行三维重建。结合本中心肝移植手术经验，提出新的肝左静脉分型，模拟切取肝脏，统计肝左静脉分型在人群中的分布情况；规划17例供肝者供肝切取及其左外叶肝移植流出道重建方案，同患儿实际流出道重建方案对比，并随访患儿手术预后情况。结果：研究对象1：纳入162例患者，根据本研究提出的标准进行肝左静脉分型，将其分为5型。其中：I型97例(59.88%)，II型6例(3.70%)，III型36例(22.22%)，IV型14例(8.64%)，V型9例(5.56%)。研究对象2：纳入于本中心行肝移植供–受者17对。分析后供者分型为：I型11例(64.7%)，III型4例(23.5%)，IV型1例(5.9%)，V型1例(5.9%)。同患儿实际手术方案进行对比，17例方案中，有11例(64.7%)同实际手术流出道重建方案基本吻合；17例患儿中，1例患儿术后3月出现流出道血流异常，予以行介入球囊扩张后肝静脉血流恢复正常，规律复查肝脏超声未再次出现血流异常。3例患儿肝移植术后1周内出现肝动脉血管并发症，予以二次肝移植术。结论：Hisense CAS基于增强CT的三维重建技术可于手术前可视化重建患者肝脏及其肝内血管分支系统，为肝左静脉分型的制定及手术方案的规划提供指导与依据。术前根据肝左静脉血管分型合理规划肝静脉流出道的重建方式，有望指导儿童左外叶肝移植手术肝静脉流出道重建的术前规划及实施及预防肝移植术后并发症，但仍需注意根据患者实际情况，个体化制定手术方案。

Abstract: Objective: The aim is to utilize the Hisense Computer-Assisted Surgery System (Hisense CAS) for the reconstruction and analysis of the course and variations of the left hepatic vein branches, along with measuring their corresponding reflux volume. Additionally, the goal is to propose a novel classification method for left hepatic veins and explore their distribution within the population. Furthermore, it aims to investigate the value of this classification in the reconstruction of outflow tracts during left lateral lobe liver transplantation in children. Methods: Data collection included original imaging data of patients who underwent contrast-enhanced CT examinations of the upper abdomen at Qingdao University Affiliated Hospital from January 1, 2021, to December 31, 2021, totaling 162 patients (Study Group 1). Clinical data of pediatric patients who underwent left lateral lobe liver transplantation surgery and their donors at the Organ Transplantation Center of Qingdao University Affiliated Hospital from January 1, 2019, to December 31, 2022, were also collected, totaling 17 pairs of patients (Study Group 2). Three-dimensional reconstruction of the liver and its internal vessels was performed using Hisense CAS technology. Based on the liver transplantation experience of our center, a new classification of the left hepatic vein was proposed, simulated liver resection was conducted, and the distribution of left hepatic vein types in the population was statistically analyzed. Reconstruction plans for liver procurement and outflow tract during left lateral lobe liver transplantation were designed for 17 donors, compared with the actual reconstruction plans for the recipients, followed by postoperative follow-up evaluations of the recipients’ surgical outcomes. Results: Study Group 1 comprised 162 patients, classified into five types of left hepatic veins according to the criteria proposed in this study: Type I (97 cases, 59.88%), Type II (6 cases, 3.70%), Type III (36 cases, 22.22%), Type IV (14 cases, 8.64%), and Type V (9 cases, 5.56%). Study Group 2 included 17 donor-recipient pairs. After analysis, the distribution of donor types was as follows: Type I (11 cases, 64.7%), Type III (4 cases, 23.5%), Type IV (1 case, 5.9%), and Type V (1 case, 5.9%). Among the 17 reconstruction plans, 11 (64.7%) were largely consistent with the actual surgical plans. One recipient developed abnormal outflow tract blood flow three months after surgery, which was corrected by balloon angioplasty. Regular ultrasound examinations showed no recurrence of abnormal blood flow. Three recipients developed complications of hepatic artery vessels within one week after liver transplantation and required retransplantation. Conclusion: Hisense CAS utilizes enhanced CT-based three-dimensional reconstruction technology to visualize and reconstruct the liver and its intrahepatic vascular branching system before surgery, providing guidance and basis for the classification of hepatic left veins and planning of surgical procedures. Preoperatively, rational planning of the reconstruction method for the hepatic venous outflow tract based on the classification of hepatic left veins is expected to guide the preoperative planning, implementation, and prevention of complications after pediatric left lobe liver transplantation, but it is still necessary to individualize the surgical plan according to the actual condition of the patients.