术前模拟肝脏手术在肝脏切除术中的应用  

Application of preoperative virtual hepatic resection for major hepatectomy

作　　者：周晓俊[1] 秦磊[2] 钱海鑫[2] 张卫国[3] 郭亮[3] 

机构地区：[1]苏州大学附属第一医院腹腔镜外科,江苏省215006 [2]苏州大学附属第一医院普通外科,江苏省215006 [3]苏州大学附属第一医院影像中心,江苏省215006

出　　处：《江苏医药》2013年第13期1560-1563,共4页Jiangsu Medical Journal

基　　金：江苏省自然科学基金(BK2007057)

摘　　要：目的探讨术前应用肝脏三维重建模型进行模拟肝脏手术的临床意义。方法选择较复杂的肝大部分切除术患者22例,术前行64-MSCT薄层扫描,将获得的影像数据导入Myrian?XP-Liver医学影像分析系统,分别由1名外科医生和1名影像科医生将扫描图像三维重建进行虚拟肝脏切除手术。结果 6例患者通过预后风险分析,调整了手术方案。22例患者都施行了肝脏大部分切除术。其中的20例完整切除肿瘤达到R0切除。2例为R1切除:1例原发性肝癌切缘最小距离<4mm,切缘阳性;另1例肝门部胆管癌,术后病理证实胆管断端阳性。全组无手术死亡和住院期间死亡病例。结论应用Myrian?XP-Liver医学影像分析系统进行肝脏三维重建及模拟肝脏切除手术,可以为施行复杂肝脏大部分切除术患者制定合理的手术方案和采取正确的术中策略提供重要的术前参考。Objective To evaluate the significance of preoperative virtual hepatic resection for major hepatectomy. Methods Twenty-two consecutive patients undergoing major hepatectomy underwent multislice CT scanning. The imaging data were imported into Myrian XP-Liver system （Intrasense, France）. And then, the three-dimensional reconstruction models were performed for virtual hepatectomy. Results On the basis of the results of computer-assisted risk analysis, the operation plan and surgical strategies were changed in 6 cases. The major complicated hepatectomy was performed in 22 patients,of whom 20 cases achieved R0 resection and 2 cases did R1 resection. The microscopic tumor cells were found on the cutting margin of the right portal vein and bile duct in the other 2 cases. There was no dead case during surgery or hospital stay. Conclusion By Myrian XP-Liver system,the application of hepatic three^dimensional reconstruction and virtual hepatectomy can provide the important preoperative valuable references for making scientific surgical plan and intraoperative strategy in the patients undergoing major and complex hepatectomy.

关 键 词：肝切除术 肝脏三维重建 

分 类 号：R657[医药卫生—外科学]