三维影像分析在Bismuth-Corlette Ⅲ型肝门部胆管癌治疗中应用价值  

The value of 256-MDCT three-dimensional image analysis in the treatment of hepatic hilar cholangiocarcinoma of Bismuth-Corlette Ⅲ-type

作　　者：王坤 何忠野 刘也夫 尚海 郝志强 傅熙博 马作红 冯照强 李文心 王鑫 张闻辉 华向东 韩磊[2] WANG Kun;HE Zhong-ye;LIU Ye-fu;SHANGHai;HAO Zhi-qiang;FU Xi-bo;MA Zuo-hong;FENG Zhao-qiang;LI Wen-xin;WANG Xin;ZHANG Wen-hui;HUA Xiang-dong;HAN Lei(Department of Hepatobiliary and Pancreatic Surgery,Liaoning Cancer Hospital＆Institue,Shenyang 110042,China)

机构地区：[1]中国医科大学肿瘤医院(辽宁省肿瘤医院)肝胆胰外科,辽宁沈阳110042 [2]沈阳军区总医院肝胆外科,辽宁沈阳110016

出　　处：《临床军医杂志》2018年第8期858-861,共4页Clinical Journal of Medical Officers

基　　金：辽宁省卫生计生委围肝门区切除在肝门胆管癌的临床治疗项目(LNCCC-B09-2014)

摘　　要：目的探讨三维影像分析在Bismuth-CorletteⅢ型肝门部胆管癌治疗中的应用价值。方法选取中国医科大学肿瘤医院(辽宁省肿瘤医院)自2012年1月至2016年12月收治的25例行联合肝切除、肝门部胆管癌切除术的Bismuth-CorletteⅢ型肝门部胆管癌患者为研究对象。应用IQQA-Liver进行肝三维重建,构成模拟旋转图像,术前精细了解肝门部血管、胆管的解剖变异,并通过模拟手术明确剩余肝体积,达到肝门胆管癌手术治疗的精细化标准。结果通过手术证实,术前模拟手术与实际操作一致。余肝量的肝三维重建系统软件测量值、实际测量分别为(809.44±75.63)cm^2、(926.83±94.75)cm^2,差异无统计学意义(P>0.05)。切除肝体积比的肝三维重建系统软件测量值、实际测量值分别为(46.92%±8.67%)、(50.81%±10.39%),差异无统计学意义(P>0.05)。结论CT三维重建模拟可视技术,在Bismuth-CorletteⅢ型肝门胆管癌根治手术评估和规划指导中具有一定的临床应用价值。Objective To evaluate the value of 256-MDCT three-dimensional image analysis in the treatment of typeⅢBismuth-Corlette hilar cholangiocarcinoma.Methods A retrospective study was performed on 25 cases of patients with typeⅢBismuth-Corlette hilar cholangiocarcinoma who were admitted from January 2012 to December 2016.Three dimensional reconstruction of liver was performed using IQQA-Liver.An analog rotating image was constructed.Prior to surgery,detailed understanding of the hepatic portal vessels and anatomic variations of the bile ducts were performed.By simulating the operation,the remaining liver volume was determined,and the fine standard for surgical treatment of hilar cholangiocarcinoma was achieved.Results The operation proved that the simulated operation was in accordance with the actual operation.Compared with the liver volume,there was no statistical difference between the measured values of the 3D reconstruction system software and the actual measurements[（809.44±75.63）cm^2versus（926.83±94.75）cm^2,P〈0.05].The volume ratio of liver resection was calculated,and the software value of liver 3D reconstruction system（46.92%±8.67%）was not different from the actual measurement value[（50.81%±10.39%）,P〈0.05].Conclusion CT threedimensional reconstruction simulation visualization technology has certain clinical value in the evaluation and surgical planning instruction of Bismuth-Corlette typeⅢhepatic hilar cholangiocarcinoma.

关 键 词：三维影像分析 Bismuth-Corlette Ⅲ型肝门部胆管癌 余肝量 切除肝体积比 

分 类 号：R73[医药卫生—肿瘤]