三维可视化技术在复杂性肝癌切除手术中的临床应用价值  

Clinical applicaton of three-dimensional visualization technology in hepatectomy of complex hepatocellular carcinoma

作　　者：韦猛 叶甲舟[1] 白涛[1] 陈洁[1] 麦荣云 彭雨蒙 张连达 陈智炜 黎乐群[1] 吴飞翔[1] Wei Meng;Ye Jiazhou;Bai Tao;Chen Jie;Mai Rongyun;Peng Yumeng;Zhang Lianda;Chen Zhiwei;Li Lequn;Wu Feixiang(Department of Hepatobiliary Surgery,Affiliated Tumor Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,南宁530021

出　　处：《中华肝胆外科杂志》2019年第9期653-655,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：广西科学技术厅重点研发课题(桂科AB16380242);广西高校中青年教师基础能力提升项目(2017KY0115);创新驱动发展专项(桂科AA18221001)。

摘　　要：目的探讨三维可视化技术在复杂性肝癌切除手术中的临床应用价值。方法回顾分析2017年6月至2018年6月广西医科大学附属肿瘤医院肝胆外科28例复杂性肝癌患者资料,其中男性26例,女性2例,年龄(46±10)岁。所有患者在三维可视化技术的指导下制定手术方案并实施手术切除。记录患者的实际手术方式、手术时间、术中出血量以及术后并发症等。比较虚拟切除肝体积与实际切除肝体积、虚拟手术切缘与实际手术切缘。结果28例复杂性肝癌患者均完成三维可视化分析,能清晰观察到肿瘤位置、形态、数量等。其中27例完成了手术切除,解剖性肝切除13例,非解剖性肝切除14例。手术时间为145~350 min,中位手术时间为240 min,术中出血量为100~1 500 ml,中位术中出血量为300 ml。术后切口愈合延迟4例,胸腔积液8例,腹腔积液2例。27例复杂性肝癌患者虚拟切除肝体积与实际切除肝体积比较,差异无统计学意义(P>0.05)。患者虚拟切除肝体积和实际切除肝体积呈正相关(r=0.986,P<0.05)。虚拟手术切缘与实际手术切缘比较,差异无统计学意义(P>0.05)。模拟切缘与实际切缘呈正相关(r=0.983,P<0.05)。结论三维可视化技术可精准评估肝脏状况,优化手术方案,在复杂性肝癌的精准肝切除中有重要的指导作用。Objective To study the clinical application of three-dimensional(3D)visualization technology in liver resection of complicated liver cancer.Methods A retrospective analysis of 28 patients with complicated liver cancer treated from June 2017 to June 2018 in the Department of Hepatobiliary Surgery,the Affiliated Tumor Hospital of Guangxi Medical University.There were 26 males and 2 females,aged(46±10)years old.A treatment plan on how to perform liver resection for these patients was developed under the guidance of 3D visualization technology.The actual surgical procedures,operation time,intraoperative blood loss,and postoperative complications were documented.The virtual resected liver volume was compared with the actual resected liver volume.The virtual surgical resection margin was also compared with the actual surgical resection margin.Results All the 28 patients with complicated liver cancer completed the 3D visualization analysis with the location,shape and quantity of tumor being clearly shown.Of the 27 patients who underwent liver resection,13 underwent anatomical hepatectomy,and 14 underwent non-anatomical hepatectomy.The operation time ranged from 145 to 350 min(median 240 min).The intraoperative blood loss ranged from 100 to 1 500 ml(median 300 ml).The incisional wound healed slowly in 4 patients,pleural effusion developed in 8 patients,and ascites in 2 patients.There were no significant differences in the virtual resected liver volume compared with the actual resected liver volume(P>0.05).There was an excellent positive correlation between the patient's virtual resected liver volume and the actual resected liver volume(r=0.986,P<0.05).There was no significant difference between the virtual surgical resection margin and the actual surgical resection margin(P>0.05).There was an excellent positive correlation between virtual surgical resection margin and the actual surgical resection margin(r=0.983,P<0.05).Conclusion Three-dimensional visualization technology accurately assessed the liver status,optimized

关 键 词：成像 三维化 复杂性肝癌 精准肝切除 术前规划 

分 类 号：R73[医药卫生—肿瘤]