计算机辅助手术规划系统在复杂肝门部胆管癌根治性切除术中的应用  

Application of a computer-assisted operation planning system in curative hepatectomy for complex hilar cholangiocarcinoma

作　　者：杨世忠[1] 顾万清[1] 段伟东[1] 王学栋[1] 陈继业[1] 董家鸿[1] 

机构地区：[1]解放军总医院肝胆外科医院、全军肝胆外科研究所,北京100853

出　　处：《中华消化外科杂志》2012年第2期124-128,共5页Chinese Journal of Digestive Surgery

基　　金：国家科技支撑计划项目（2012BA106B01）

摘　　要：目的评价计算机辅助手术规划系统在复杂肝门部胆管癌切除术中的应用价值。方法回顾性分析2008年1月至2009年12月解放军总医院收治的15例复杂肝门部胆管癌患者的临床资料，通过计算机辅助手术规划系统对患者的cT扫描数据进行三维重建及术前评估，包括肿瘤与相邻脉管的解剖关系、肝脏体积、可切除性等，评估的准确性通过术中及术后结果验证。术前预切除肝脏体积与术后实际切除肝脏体积的相关性检验采用Pearson等级相关分析，三维和二维方法计算的肝脏体积间的比较采用配对t检验，误差率的比较采用X。检验。结果15例患者均接受了根治性切除，其中扩大半肝切除8例、肝脏左右三区切除7例。术前三维重建对重要血管及胆管解剖学评估结果与术中所见相符。三维方法评估门静脉和肝动脉受累的敏感度、特异度和准确率分别为100．0％、72．7％、72．7％和100．0％、78．6％、78．6％。术前预切除肝脏体积与术后实际切除肝脏体积呈正相关（r=0．974，P〈0．05）。三维和二维方法计算的预切除肝脏平均体积分别为（458±86）ml和（491±103）ml，两者比较，差异无统计学意义（t=-1．911，P〉0．05）；两种方法计算的肝脏切除体积的平均误差率分别为4．7％和7．2％，两者比较，差异无统计学意义（x2=2．381，P〉0．05）。本组患者手术并发症发生率为5／15，均经保守或介入治疗痊愈。结论计算机辅助手术规划系统有助于复杂肝门部胆管癌根治性切除术的术前评估，对提高手术的安全性和准确性有重要临床意义。Objective To evaluate a computer-assisted operation planning system in curative hepatectomy for complex hilar cholangiocarcinoma. Methods The clinical data of 15 patients with complex hilar cholangiocarcinoma who were admitted to the Chinese PLA General Hospital from January 2008 to December 2009 were retrospectively analyzed. Based on triple-phase contrast-enhanced computed tomography images, a computer-assisted operative planning system was used to evaluate the anatomic relationship between the tumor and its adjacent vessels, liver volume, operative feasibility, and the potential surgical approaches. The accuracy of three-dimensional reconstruction was tested by comparison to actual intraoperative findings. The correlation between actual liver resection volumes and predicted liver resection volumes was analyzed by calculating a Pearson correlation coefficient. Differences in liver volumes calculated by two-dimensional techniques versus three-dimensional reconstruction were analyzed using the paired t test, and the error rate was compared using the chi-square test. Results Fifteen patients received curative hepatectomy, including extended hemihepatectomy in 8 patients and trisectionectomy in 7 patients. Preoperative evaluation of the hepatic anatomy based on three-dimensional reconstruction imaging was confirmed with operative findings. The sensitivity, specificity and accuracy rates were 100.0%, 72.7% and 72.7% for patients with portal invasion and 100.0%, 78.6% and 78.6% for patients with hepatic arterial invasion, respec- tively. The actual liver resection volume was positively correlated with the predicted liver resection volume （r = 0. 974, P 〈 0.05 ）. The mean liver volumes calculated by the three-dimensional reconstruction and the two-dimen- sional techniques were （458±86 ）ml and （491 ±103 ）ml, respectively, with no significant difference （t = - 1.911, P 〉 0.05 ）. The error rates of the three-dimensional reconstruction and the two-dimensional techniques were 4.7% and 7.2%, respectiv

关 键 词：胆管肿瘤 肝门部 三维重建 手术规划 肝切除术 

分 类 号：R735.8[医药卫生—肿瘤]