目的

探讨构建肝脏体模在真实介入手术环境中实施经颈静脉肝内门体分流术（transjugular intrahepatic portosystemic shunt，TIPS）训练的方法学要素。

方法

回顾性分析在川北医学院附属南充市中心医院行TIPS 治疗的36 例患者的DSA 影像资料，筛选3 例典型病例的增强CT 的薄层数据作为母版，经Mimics 软件和3D MAX 软件提取、重建及圆滑处理肝静脉、门静脉、下腔静脉、肝脏的模型，建立门静脉与肝静脉间的连接模型及铸模模具的模型。对不同邵氏硬度的硅胶块进行针刺测试硬度，经3D 打印上述模型后注入用于模拟硬化肝脏的硅胶进行铸模及脱模操作。按照血液循环原理建立管道路径并与肝脏硅胶模型及潜水泵连接，对该模型进行CT 扫描及数字减影血管造影（digital subtraction angiography，DSA）下的TIPS 模拟训练，评估模型的可靠性及逼真度。

结果

关键要素包括：门静脉分支与肝静脉分支的小直径管道连接模型及铸模模具模型的三维建模、模具的脱模。邵氏硬度为10°的硅胶可模拟硬化较重的肝脏，5°的硅胶可模拟硬化较轻的肝脏。模型的CT 图像能实现肝静脉穿刺门静脉路径的规划，模型内部及各接口表现出较好的防渗漏特性，肝静脉及门静脉造影过程与真实手术相似，肝脏的穿刺过程具有逼真的阻力反馈。

结论

构建包含肝静脉、门静脉的肝脏体模在技术方法上可行，具有较高的可靠性及逼真度，可用于介入医师的TIPS 模拟训练。

Objective

Exploring the methodological elements of constructing a liver phantom for training transjugular intrahepatic portal systemic shunt （TIPS） in a real interventional procedure environment.

Methods

A retrospective analysis was conducted on the DSA image data of 36 patients treated with TIPS in our hospital.Three typical cases' enhanced CT thin-layer data were selected as the master version.Mimics software and 3D MAX software were used to extract， reconstruct， and smooth the models of hepatic vein，portal vein， inferior vena cava， and liver.The connection model between portal vein and hepatic vein and the mold model were established.The hardness of silicone blocks with different Shore hardness was tested by needle puncture.After 3D printing the above model， and the silicone for simulating hardened liver was injected for molding and demolding operations.The pipeline path was established according to the principle of blood circulation and connected to the liver silicone model and submersible pump.CT scanning and TIPS simulation training under digital subtraction angiography （DSA） were performed on the model to evaluate its reliability and realism.

Results

The key elements of this study included the three-dimensional modeling of small-diameter connecting pipes and mold molds for portal vein branches and hepatic vein branches， as well as the demolding operation of the molds.Silicone with a Shore hardness of 10° could simulate liver with heavier hardening， while silicone with a Shore hardness of 5° could simulate liver with lighter hardening.The CT images of the model could achieve path planning for portal vein puncture from the hepatic vein，and the internal and various interfaces of the model showed good anti-leakage characteristics.The hepatic vein and portal vein imaging were similar to real procedure， and the liver puncture process had realistic resistance feedback.

Conclusion

The construction of a liver phantom containing hepatic veins and portal veins is technically feasible， with high reliability and realism， and can be used for TIPS simulation training of interventional physicians.