虚拟肝切除技术在肝癌切除中的临床应用  

Clinical application of virtual hepatectomy in treatment of primary hepatocellular carcinoma

作　　者：黄从云[1] 孟志华[2] 陈振松[1] 吴青松[1] 朱剑华[1] 张小龙 赵家锋[1] 万志方[1] 潘高升[1] 黎丽[1] 卢雨零[1] 

机构地区：[1]汕头大学医学院附属粤北人民医院肝胆外科,512026 [2]汕头大学医学院附属粤北人民医院影像科,512026

出　　处：《中华肝胆外科杂志》2010年第4期249-252,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨虚拟肝切除技术在肝癌切除中的价值.方法 2007年9月至2008年9月对13例肝癌病人术前行常规Flash3D增强扫描,用3D-Doctor软件行包括下腔静脉、门静脉、肝静脉和肝短静脉的三维影像重建,测量全肝体积、肿瘤体积、拟切除的肝脏体积、余肝体积和余肝体积/标准肝体积（SFLVR）.结果 7例行右半肝切除,6例肝段/叶切除.肝脏三维重建后均能从各个角度显示肝内静脉走向及与肿瘤的空间关系,肿瘤体积为（348±214）ml,拟切除肝体积为（676±375）ml,余肝体积为（714±261）ml,SFLVR为62%±19%.术后并发症包括肺1例肺部感染,中等量腹水6例,大量腹水2例,其中1例肝功能不全.结论 虚拟肝切除技术能直观显示肝脏静脉以及与肿瘤的关系,预测肝切除量,对制定肝脏手术方案具有实用价值.Objective To assess the feasibility of virtual hepatectomy in the treatment of primary hepatocellular carcinom（PHCC）.Methods From September 2007 to September 2008,three-dimensional（3D）models from MR images were constructed by 3D-Doctor software in 13 patients with PHCC scheduled for liver resection.From these 3D models,the images of vena cava,portal vein,hepatic vein and short hepatic vein were reconstructed and total liver volume,tumor volume,functional liver volume and SFLVR（ratio of functional liver volume to standard liver volume）were calculated.Results Of the 13 patients with PHCC,7 received right hemihepatectomy and 6 bisegmentectomy.The anatomic detail of liver veins and its relation to the tumor could be displayed clearly in liver 3D models.By the 3D models,tumor volume was calculated as（348±214）ml,total liver volume（676±375）ml,functional liver volume（714 ± 261）ml and SFLVR（62±19）%.Postoperative complications included pulmonary infection in 1,moderate ascites in 6 and massive ascites in 2.Conclusion Virtual hepatectomy provides an accurate picture of liver vein anatomy and its relationship with the tumor.It can predict the liver volume to be removed and functional liver volume,and may be used for the preoperative planning of safe hepatectomy.

关 键 词：癌 肝细胞 虚拟肝切除 磁共振扫描 

分 类 号：R735.7[医药卫生—肿瘤]