三维可视化技术用于1665例原发性肝癌精准诊治的多中心回顾性研究  

Efficacy of three-dimensional visualization technology in the precision diagnosis and treatment for primary liver cancer: a retrospective multicenter study of 1 665 cases in China

作　　者：方驰华[1] 张鹏[1] 周伟平 周俭 戴朝六[4] 刘景丰 荚卫东 梁霄[7] 曾思略 文赛 Fang Chihua;Zhang Peng;Zhou Weiping;Zhou Jian;Dai Chaoliu;Liu Jingfeng;Jia Weidong;Liang Xiao;Zeng Silue;Wen Sai(First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University,Guangdong Provincial Clinical and Engineering Center of Digital Medicine,Guangzhou 510282,China;Third Department of Hepatic Surgery,Eastern Hepatobiliary Surgery Hospital,Affiliated to Naval Medical University,Shanghai 200433,China;Department of Liver Surgery and Transplantation,Liver Cancer Institute,Zhongshan Hospital,Fudan University,Shanghai 200438,China;Department of Hepatobiliary Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China;Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350025,China;Department of General Surgery,First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China;Department of General Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310016,China)

机构地区：[1]南方医科大学珠江医院肝胆一科广东省数字医学临床工程技术研究中心,广州510282 [2]海军军医大学东方肝胆外科医院肝外三科,上海200433 [3]复旦大学附属中山医院肝外科,上海200438 [4]中国医科大学附属盛京医院肝胆脾外科,沈阳110004 [5]福建医科大学孟超肝胆医院,福州350025 [6]中国科学技术大学附属第一医院肝脏外科,合肥230001 [7]浙江大学医学院附属邵逸夫医院普通外科,杭州310016

出　　处：《中华外科杂志》2020年第5期375-382,共8页Chinese Journal of Surgery

基　　金：国家重点研发计划数字诊断与治疗装备研发重点专项(2016YFC0106500);国家高技术研究发展计划(863计划)(2006AA02Z346、2012AA021105);国家重大科研仪器研制项目(81627805);国家自然科学基金-广东联合基金(U1401254);广东省自然科学基金(6200171);广东省重大科技专项计划项目(2012A080203013);广东省部产学研结合项目(2009B080701077);广州市科技计划项目(201604020144)。

摘　　要：目的探讨三维可视化技术在原发性肝癌精准诊治中的效果。方法回顾性分析2009年1月至2019年1月我国7家医疗中心使用三维可视化技术精准诊治的1665例原发性肝癌患者的临床资料。男性1255例(75.4%),女性410例(24.6%),年龄(52.9±11.9)岁(范围:18~86岁)。采用质控化手段采集高质量亚毫米CT图像数据,使用同质化手段进行三维重建和三维可视化分析。记录术后病理学检查结果、微血管侵犯、围手术期并发症、随访资料等。采用SPSS 25.0统计软件根据资料类型对临床数据进行统计描述与分析。采用Kaplan-Meier曲线计算总体生存率和无瘤生存率。结果(1)三维可视化图像显示,1665例患者的肿瘤最大径≤2 cm者155例(9.31%),>2~5 cm者551例(33.09%),>5~10 cm者636例(38.20%),>10 cm者323例(19.40%)。(2)肝脏血管的分型:①肝动脉:Ⅰ型(正常型)肝动脉1494例(89.73%);变异肝动脉171例(10.27%),其中Ⅱ型35例,Ⅲ型38例,其他类型98例;②肝静脉:Ⅰ型(正常型)肝静脉1195例(71.77%);变异肝静脉470例(28.23%),其中Ⅱ型376例,Ⅲ型94例;③门静脉:正常型门静脉1315例(78.98%);变异门静脉350例(21.02%),其中Ⅰ型变异189例,Ⅱ型变异103例,Ⅲ型变异50例,Ⅳ型变异8例;④肝动脉并存门静脉变异24例(1.44%);⑤肝静脉并存门静脉变异113例(6.79%);⑥并存3种脉管变异4例(0.24%),其中肝动脉Ⅱ型变异、门静脉Ⅰ型变异并存肝静脉Ⅲ型变异2例;肝动脉Ⅲ型变异、门静脉Ⅲ型变异并存肝静脉Ⅱ型变异2例。(3)术前肝体积计算:总肝体积为1499.3(514.4)ml[M(QR),范围:641.7~6637.0 ml],肝切除体积为479.1(460.1)ml(范围:10.5~2086.8 ml),剩余功能肝体积为959.9(460.4)ml(范围:306.1~5638.0 ml)。(4)手术方式:解剖性肝切除1458例(87.57%);非解剖性肝切除207例(12.43%)。(5)手术时间285(165)min(范围:40~720 min)。(6)术中出血量200(250)ml(范围:10~4200 ml),术中输血346例(20.78%)。(7)病理学诊断:肝细胞肝癌1371例(8Objective To evaluate the efficacy of three-dimensional(3D)visualization technology in the precision diagnosis and treatment for primary liver cancer.Methods A total of 1665 patients with primary liver cancer who admitted to seven medical centers in China between January 2009 to January 2019,diagnosed and treated by 3D visualization protocol were analyzed,and their clinical data were retrospectively reviewed.There were 1255 males(75.4%)and 410 females(24.6%),with age of(52.9±11.9)years(range:18 to 86 years).The acquisition of high-quality CT images with submillimeter spatial resolution were conducted using a quality control system.By means of homogenization methods,3D reconstruction and 3D visualization analysis were performed.Postoperative observation:pathology reports,microvascular invasion,perioperative complications and follow-up.SPSS 25.0 statistical software was used for statistical description and analysis of clinical data.Kaplan-Meier curve was used to calculate overall survival and disease-free survival rate.Results(1)In the sample of 1265 patients,3D reconstructed models clearly displayed as follows.tumor size:≤2 cm in 155 cases(9.31%),>2 cm to 5 cm in 551 cases(33.09%),>5 cm to 10 cm in 636 cases(38.20%),>10 cm in 323 cases(19.40%).(2)Classification of hepatic blood vessels.Hepatic artery:typeⅠ(normal type)in 1494 cases(89.73%),variant hepatic artery in 171 cases(10.27%),including typeⅡin 35 cases,typeⅢin 38 cases,and other types in 98 cases.Hepatic vein:typeⅠ(normal)in 1195 cases(71.77%),variant hepatic veins in 470 cases(28.23%),including typeⅡin 376 cases and typeⅢin 94 cases.Portal vein:normal type in 1315 cases(78.98%),variant portal veins in 350 cases(21.02%),including typeⅠin 189 cases,typeⅡin 103 cases,typeⅢin 50 cases,typeⅣin 8 cases.Hepatic artery variation coexisting with portal vein variation in 24 cases(1.44%).Hepatic vein variation coexisting with portal vein variation in 113 cases(6.79%).Three types of vascular variation in 4 cases(0.24%),including coexistence of t

关 键 词：肝肿瘤 诊断 三维可视化 术前规划 疗效评估 

分 类 号：R735[医药卫生—肿瘤]