肝周下腔静脉数字模型的建立

Establishment of a digital model of juxtahepatic vena cava

  • 摘要: 目的:探讨根据CT检查数据建立肝周下腔静脉数字模型的可行性。
    方法:选取2013年1〖KG-*2〗-5月沧州市中心医院120例受试者(无肝脏基础疾病者)的临床资料。分析受试者CT检查图像,设定肝周下腔静脉4个层次(P1:下腔静脉入右心房水平、P2:肝静脉根部汇入下腔静脉上缘水平、P4:下腔静脉肝脏下缘水平、P5:肾静脉根部汇入下腔静脉上缘水平)测量周长及各层次间的垂直距离。在假设肝周下腔静脉完全充盈前提下,利用周长计算出肝周下腔静脉各层次的理论直径(P1D、P2D、P3D、P4D),结合不同层次间垂直距离(P1P2L、P2P4L、P1P4L、P4P5L)推导关系式,制作肝周下腔静脉数字模型。对测量数据使用方差分析配对样本t检验及独立样本t检验,使用相关及回归方法分析数据间关系。
    结果:3例受试者同时缺失P1与P2层次数据,8例受试者缺失P4层次数据。各层次理论直径:P1D为(28.1±4.0)mm,P2D为(28.7±3.5)mm,P4D为(23.5±2.7)mm,P5D中位值为24.3mm,P1P2P4层次间下腔静脉为一个中间略微突出的柱形立体结构。P1DP2D,P2DP4D,P1DP4D之间直径差距比较,差异有统计学意义(F=77.5,P<0.05)。进一步分析发现P2DP4D和P1DP4D直径差距比较,差异有统计学意义(t=14.893,11.210,P<0.05)。各层次垂直距离:P1P2L中位值为7.5 mm,P1P4L为(85.2±11.0)mm,P2P4L为(78.2±9.8)mm,P4P5L中位值为10.0 mm。P1DP2D、P2DP4D、P2DP5D、P4DP5D之间数据变化呈正相关(r=0.862,0.308,0.186,0.788,P<0.05),P1DP4D和P2DP5D则无相关性(r=0.180,0.118,P>0.05)。P2D与体质量有关,P5D与年龄有关(r=0.200,0.130,P<0.05)。男性受试者和女性受试者的下腔静脉P1D、P2D、P4D和P5D分别为(28.5± 3.7)mm和(27.8±4.2)mm、(29.0±3.4)mm和(28.5±3.6)mm、 (23.9±2.8)mm和(23.1±2.5)mm、(24.3± 2.6)mm和24.0 mm(非正态分析为中位数据),在不同性别之间理论直径比较,差异无统计学意义(t=0.911,0.809,1.588,1.902,P>0.05)。P1D和P2D与P1P2L呈负相关(r=〖KG-*4〗-0.245,-0.160, P<0.05),P1D而与P4P5L呈正相关(r=0.149,P<0.05);P2D与P2P4L呈正相关(r=0.195,P<0.05)。P1P2L与受试者年龄、身高、体质量无关(r=〖KG-*4〗-0.092,-0.047,-0.033,P>0.05),P2P4L、P1P4L均与受试者年龄呈现负相关(r=〖KG-*4〗-0.343,-0.371,P<0.05),与体质量呈现正相关(r=0.271,0.208,P<0.05),P4P5L与身高和体质量呈正相关(r=0.154,0.255,P<0.05)。不同性别间P1P2L、P1P4L、P2P4L、P4P5L比较,差异均无统计学意义(t=〖KG-*4〗-1.046,-1.274,-0.908,1.375,P>0.05)。P2P4L长度接近肝后下腔静脉长度,推导出关系式:P2P4L(mm)=71.23〖KG-*2〗-0.293×年龄(岁)+0.32×体质量(kg)。
    结论:根据CT检查数据建立肝周下腔静脉数字模型简便可行,能为相关的临床研究提供实验依据。

     

    Abstract: Objective:To investigate the feasibility of establishing a digital model of juxtahepatic vena cava.
    Methods:The clinical data of 120 participants (without liver diseases) who were admitted to the Cangzhou Central Hospital from January 2013 to May 2013 were collected. The results of computed tomography were analyzed. The diameters of juxtahepatic vena cava on different levels (P1 plane: inferior vena cava at the entrance to the right atrium, P2 plane: the upper margin of the roots of hepatic veins, P4 plane: lower boundary of liver, P5 plane: confluence of renal veins and inferior vena cava), and the circumference of the inferior vena cava and the lengths between these levels were recorded. A digital model of juxtahepatic vena cava was established by these data on the premise that the juxtahepatic vena cava was engorged. All data were analyzed using the analysis of variance, paired sample t test and independent samples t test, and correlation and regression were used in analysis of relations between there data.
    Results:Data of the P1 plane and P2 plane were both missed in 3 cases, and 〖HJ*4〗the data of the P4 plane was missed in 8 cases. The theoretical diameter of hepatic vena cava at the P1, P2 and P4 planes were (28.1±4.0)mm, (28.7±3.5)mm and (23.5±2.7)mm, respectively. The median diameter of hepatic vena cava at the P5 plane was 24.3 mm. The juxtahepatic vena cava was a 3 dimensional structure of cylinder with a slightly protruding middle part. There were significant differences in P1D P2D, P2D P4D, P1D P4D (F=77.5, P<0.05). There were significant differences between P2D P4D and P1D P4D (t=14.893, 11.210, P<0.05). The median length of hepatic vena cava between P1 and P2 planes was 7.5 mm. The lengths of hepatic vena cava between P1 and P4 planes, P2 and P4 planes were (85.2±11.0)mm and (78.2±9.8)mm, respectively. The median length of hepatic vena cava between the P4 and P5 planes was 10.0 mm. P1D P2D, P2D P4D, P2D P5D and P4D P5D were positively correlated (r=0.862, 0.308, 0.186, 0.788, P<0.05), while P1D P4D and P2D P5D did not correlated (r=0.180, 0.118, P>0.05). P2D was correlated with the body weight, and P5D was correlated with the age (r=0.200, 0.130, P<0.05). The P1D, P2D, P4D and P5D of the inferior vena cava were (28.5±3.7)mm, (29.0±3.4)mm, (23.9±2.8)mm and (24.3±2.6)mm in males, and (27.8±4.2)mm, (28.5±3.6)mm, (23.1±2.5)mm and 24.0 mm in females. There were no significant difference in P1D, P2D, P4D and P5D between males and females (t=0.911, 0.809, 1.588, 1.902, P>0.05). The length between P1 and P2 planes was negatively correlated with P1D and P2D (r=〖KG-*4〗-0.245, -0.160, P<0.05), while the length between P4 and P5 planes was positively correlated with P1D (r=0.149, P<0.05). The length between P2 and P4 planes was positively correlated with P2D (r=0.195, P<0.05). The length between P1 and P2 planes did not correlated with the age, height and body weight (r=〖KG-*4〗-0.092,-0.047,-0.033, P>0.05). The lengths between P2 and P4 planes, P1 and P4 planes were negatively correlated with the age (r=〖KG-*4〗-0.343,-0.371, P<0.05), but positively correlated with the body weight (r=0.271, 0.208, P<0.05). The length between P4 and P5 planes was positively correlated with the height and body weight (r= 0.154, 0.255, P< 0.05) . There were no significant difference in the lengths between P1 and P2 planes, P1 and P4 planes, P2 and P4 planes, P4 and P5 planes between males and females (t=〖KG-*4〗-1.046,-1.274,-0.908, 1.375, P>0.05). The length between P2 and P4 planes was similar to the length of retrohepatic vena cava. The length between P2 and P4 planes(mm)=71.23〖KG-*2〗-〖KG-*5〗0.293×age (years)+0.32×body weight (kilogram).
    Conclusion: The establishment of digital model of juxtahepatic vena cava based on the computed tomography imaging data is feasible, which provides basis for clinical investigation.

     

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