Hisense CAS计算机辅助手术系统在儿童第二肝门区肿瘤手术切除中的应用  

Application of computer assisted surgical system for hilar tumor resection at second hepatic portal area in children

作　　者：崔楷悦 董蒨[1] 苏南[1] 朱呈瞻 赵静[1] 周显军[1] 张桓瑜 陈鑫[1] 鹿洪亭[1] 郝希伟[1] Cui Kaiyue;Dong Qian;Su Nan;Zhu Chenzhan;Zhao Jing;Zhou Xia-njun;Zhang Huanyu;Chen Xin;Lu Hongting;Hao Xizvei(Department of Pediatric Surgery, Affiliated Hospital, Qingdao University, Shandong Key Laboratory of Digital Medicine ＆ Computer Assisted Surgery, Qingdao 266003, China;Department of Hepatobiliary Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, China)

机构地区：[1]青岛大学附属医院小儿外科、山东省数字医学与计算机辅助手术重点实验室,山东266003 [2]青岛大学附属医院肝胆外科,青岛266003

出　　处：《中华小儿外科杂志》2018年第5期329-334,共6页Chinese Journal of Pediatric Surgery

基　　金：十二五国家科技支撑计划课题（2013BAI01B03）;基于数字肝脏大数据分析的新一代海信CAS的研发（2016GGB14019）

摘　　要：目的 对儿童肝脏肿瘤与肝静脉重要分支的位置关系、压迫、侵袭情况进行医学数字影像分析,探讨计算机辅助手术系统在儿童第二肝门区肿瘤手术切除中的应用.方法 收集2013年1月至2017年6月于青岛大学附属医院小儿外科就诊的27例累及第二肝门区肿瘤患儿资料,男19例,女8例,年龄2个月至10岁,平均（2.3±2.9）岁.肿瘤最大径21.0 cm,中位数10.2cm.所有患儿术前均采用Hisense CAS计算机辅助手术系统对肝脏进行三维重建,精准了解肝内血管与肿瘤关系,模拟肝切除,计算剩余肝脏体积,规划手术方案,观察患儿肝内血管走行及变异,评估手术方式、手术时间、术中出血量、术中输血量、术后并发症发生情况.结果 根据术前三维重建,肿瘤累及一支主肝静脉5例,累及两支主肝静脉1例,累及三支主肝静脉1例,对主肝静脉形成压迫20例,其中1例压迫下腔静脉.右半肝切除11例,左半肝切除3例,肝左三叶切除3例,肝中叶切除7例,肝右前叶切除3例.肿瘤平均体积（10.67×8.57×6.48）cm3,平均手术时间162 min（60 min～260 min）,术中中位出血量为20 ml（2 ml～400 ml）,术中平均输红细胞量为1.85 U（0.1 U～8 U）,术后平均住院10.2 d（7 d～14 d）.术后1例出现反应性胸腔积液,给予胸腔闭式引流,恢复良好.结论 应用计算机辅助手术系统可清晰准确显示小儿肝脏肿瘤与肝静脉的关系,可精准评估手术可行性,并能优化手术方案,对患儿第二肝门区肿瘤具有重要的指导意义.Objective To explore the relationship between liver tumors and hepatic veins in children and assess the clinical value of computer-assisted surgery （CAS） system for pediatric liver surgery.Methods The clinical data of 27 cases with liver tumors at second hepatic portal area was analyzed from January 2013 to June 2017.There were 19 boys and 8 girls aged from 2 months to 10 years with a mean age of （2.3± 2.9） years.Maximal and median diameters of tumor were 21.0 cm and 10.2 cm respectively.Prior to surgery,liver three-dimensional reconstruction by Hisense CAS was performed to observe the relationship between intrahepatic vessels and liver tumor and calculate the intended resection range and the remaining liver volume.Intrahepatic vascular shape and variation,surgical approach,operative duration,blood loss,intraoperative blood transfusion and postoperative complications were observed.Results According to preoperative three-dimensional reconstruction,tumors invaded single （n =5）,two （n =1） and three main hepatic veins （n =1）.Among 20 cases of oppressed main hepatic vein,inferior vena cava was oppressed in one case and another case had diffuse total hepatic lesion.Right hepatectomy （n =11）,left hepatectomy （n =3）,left trisectionectomy （n =3）,mesohepatectomy （n =7） and right anterior lobe resection （n =3） were performed.The median tumor volume was （10.67 × 8.57 × 6.48） cm3,median operative duration 162 （60-260） min,median blood loss 20 （2-400） ml,median red blood cell transfusion 1.85 （0.1-8） units and median postoperative hospitalization 10.2 （7-14） days.One case of postoperative pleural effusion was treated by closed drainage of pleural cavity.Conclusions The above CAS is capable of distinctly and accurately delineating the relationship between liver tumor and hepatic vein in children.It may evaluate the feasibility of surgery and optimize operative plans for children with second hilar tumors.

关 键 词：外科手术 计算机辅助 成像 三维 第二肝门区 肝肿瘤 肝静脉 

分 类 号：R735.7[医药卫生—肿瘤]