目的 分析门静脉系统三维解剖结构及其与左侧结直肠癌肝转移灶分布的关系。方法 选取2009年11月至2012年9月期间笔者所在医院行上腹部CT检查的181 例患者作为研究对象，观察其CT影像学资料并重建门静脉系统三维图像，进行门静脉系统解剖结构分型，并分析其中61例左侧结直肠癌伴肝转移患者的CT或MR二维图像及其临床资料，记录肿瘤原发部位，观察肝转移病灶的位置、数目以及门静脉系统的解剖类型。结果 肠系膜上静脉（SMV）和脾静脉（SV）汇合成门静脉主干（MPV），在肝门处分为门静脉右支（RPV）和门静脉左支（LPV） 进入肝脏（A型）者占83.98% （152/181），其中肠系膜下静脉（IMV）汇入SMV （A1亚型） 65例 （35.91%），IMV汇入SV （A2亚型）64例（35.36%），IMV汇入门静脉角（A3亚型） 23例（12.71%）；其他变异（B、C和D型）者29例，占16.02%。61例左侧结直肠癌伴肝转移患者中，IMV汇入门静脉角者12例，其肝转移灶均分布在肝左右叶（100%）；而IMV汇入SMV或SV者49例，其肝转移灶分布在肝左右叶者30例（61.22%），分布在肝左或右叶者19例（38.78%），两种IMV汇入门静脉类型其肝转移灶分布构成比的差异有统计学意义（P＜0.05）。在39例IMV汇入SV的患者中，肝内门静脉为2支型（A2亚型）者28例，其肝转移灶分布在肝左右叶者21例（75.00%），分布在肝左或右叶者7例（25.00%）；而肝内门静脉为3支型（B2＋C2亚型）的11例中，肝转移灶分布在肝左右叶者3例（27.27%），分布在肝左或右叶者8例（72.73%），两者的肝转移灶分布构成比的差异也有统计学意义（P＜0.01）。结论 门静脉系统的解剖结构复杂多变，与左侧结直肠癌肝转移病灶的分布密切相关。
Objective To assess the value of precise hepatectomy in treatment of primary hepatocellular carcinoma. Methods Three-dimensional (3D) models from MR image were reconstructed by 3D-Doctor software in 32 patients with primary hepatocellular carcinoma scheduled for liver resection between July 2007 and Sept 2009. From these 3D models, the vena cava, portal vein, hepatic vein, and short hepatic vein images were reconstructed, total liver volume, tumor volume, functional liver volume and ratio of functional liver volume to standard liver volume (SFLVR) were calculated. The patients were followed-up for 1-27 months, with an average of 12 months. Results The anatomic detail of liver veins and its relationship with the tumor could be displayed clearly in liver 3D models. By the 3D models, total liver volume was calculated as （1 353±419）ml, tumor volume as （287±248） ml, functional liver volume as （830±289） ml, and SFLVR as （71±22）%. Of 32 patients with hepatocellular carcinoma, right hemihepatectomy was performed in 8 cases, left hemihepatectomy in 2, and segmental or limited resection in 22. All operations were completed successfully. Postoperative complications included pulmonary infection in 1 case, bile leak in 1, moderate ascites (500-3 000 ml) in 8, and massive ascites (gt;3 000 ml) in 2 including one patient developed hepatic failure. Six and 12-month survival rates were 100% and 87%. Three, 6, and 12-month disease-free survival rates were 78%, 72%, and 72%. Conclusions Precise hepatectomy technique provides an accurate picture of liver veins anatomy and its relationship with the tumor， and allows the procedure to be simulated preoperatively for adequate and safe hepatectomy.