三维可视化技术在联合肝脏离断和门静脉结扎的分阶段肝切除术中的应用  

Application of three-dimensional visualization technology in associating liver partition and portal vein ligation for staged hepatectomy

作　　者：胡志刚[1] 黄拼搏[1] 李文滨[1] 肖治宇[1] 何传超[1] 徐康[1] 方驰华[2] 王捷[1] 

机构地区：[1]中山大学孙逸仙纪念医院肝胆外科,广州510260 [2]南方医科大学珠江医院肝胆一科,广州510282

出　　处：《中华肝脏外科手术学电子杂志》2016年第2期86-90,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81372565)

摘　　要：目的探讨三维可视化技术在联合肝脏离断和门静脉结扎的分阶段肝切除术(ALPPS)中的应用价值。方法回顾性分析2014年12月中山大学孙逸仙纪念医院收治的1例应用三维可视化技术行ALPPS的肝细胞癌(肝癌)患者临床资料。患者女,44岁,因体检发现"转氨酶升高3个月,肝脏实性占位3 d"入院。既往有乙型病毒性肝炎(乙肝)病史。入院诊断:肝右叶巨块型肝癌。患者签署已知情同意书,符合医学伦理学规定。利用CT、医学图像三维可视化系统(MI-3DVS)进行术前评估及手术规划。结果一期术前三维可视化重建测得全肝体积1 033 ml,肝左叶体积195 ml,占标准肝体积的16%,一期手术结扎门静脉右支,分离左、右半肝。术后3周再行三维可视化重建测得全肝体积1 048 ml,肝左叶体积394 ml,占标准肝体积的33%。二期行右半肝切除术。术前三维可视化图像与术中所见相符,术前规划与实际手术相符。术后无明显并发症。结论三维可视化技术是ALPPS术前精确诊断及制定详细手术规划的良好辅助方法。Objective To explore the application value of three-dimensional visualization technology in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Methods Clinical data of one patient with hepatocellular carcinoma (HCC) undergoing ALPPS using three-dimensional visualization technology were analyzed retrospectively. The patient was female, aged 44 years, was hospitalized due to transaminase elevation for 3 months and solid hepatic lesion for 3 d. She had a history of hepatitis B. She was diagnosed with massive HCC in the right liver lobe. The informed consents of the patient was obtained and the local ethical committee approval was received. Preoperative evaluation and surgical planning were performed using computer tomography (CT) scan and medical imaging three-dimensional visualization system (MI-3DVS). Results Total liver volume was 1 033 ml and the left lobe volume was 195 ml, accounting for 16%of the standard liver volume measured by three-dimensional visualization technology before the ifrst-stage surgery. The right branch of portal vein was ligated and the left and right liver lobes were separated. Total liver volume was 1 048 ml and the left lobe volume was 394 ml, accounting for 33%of the standard liver volume measured by three-dimensional visualization technology 3 weeks after surgery. Right hemihepatectomy was performed during the second stage. The ifndings of preoperative three-dimensional visualization technology were consistent with intraoperative observation. Preoperative surgical planning was in accordance with intraoperative procedures. No apparent complication was observed after surgery. Conclusion Three-dimensional visualization technology is a favorable supplementary option for ALPPS in making the preoperative precise diagnosis and detailed surgical planning.

关 键 词：联合肝脏离断和门静脉结扎的二步肝切除术 成像 三维 肝肿瘤 手术规划 

分 类 号：R735.7[医药卫生—肿瘤]