计算机三维重建技术在半肝切除术中的临床应用价值  

Three-dimensional computer reconstruction in hemihepatectomy

作　　者：王程 黄强 杨骥 Wang Cheng;Huang Qiang;Yang Ji(Department of General Surgery,Affiliated Provincial Hospital of Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院普外科,合肥230001

出　　处：《中华肝胆外科杂志》2020年第9期670-673,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：安徽省科技攻关项目(1804h08020277);国家自然科学基金(81272397);安徽省自然科学基金(1208085MH176)。

摘　　要：目的探讨术前计算机三维重建技术在半肝切除患者中的临床应用价值。方法回顾分析2017年1月至2019年8月连续在安徽医科大学附属省立医院普外科行半肝切除68例患者资料,其中男性33例,女性35例,平均年龄60.1岁。根据术前是否行三维重建分为三维组(n=30)与对照组(n=38)。比较两组术前影像诊断与术中情况的符合率,术前影像评估脉管走形与术中所见(或解剖切除标本)的符合率,以及术前影像评估切除肝体积与实际切除肝体积的符合率。结果以术中所见为准,三维组术前影像检查诊断胆管结石、肝门部胆管癌、肝占位病变与术中情况符合率96.7%(29/30),对照组符合率为94.7%(36/38),两组比较差异无统计学意义(P>0.05)。以术中所见(或解剖标本所见)为准,三维组门静脉、胆管走行术前评估与术中所见(或解剖标本所见)符合率分别为93.3%(28/30)、96.7%(29/30),对照组符合率分别为73.7%(28/38)、79.0%(30/38)。三维组肝体积符合率96.7%(29/30),对照组为79.0%(30/38)。三维组门静脉、胆管走行和切除肝体积符合情况优于对照组,差异均有统计学意义(均P<0.05)。结论术前计算机三维重建技术能明确诊断肝门部占位、胆管结石,可精准描述脉管走行,在半肝切除中有重要的临床应用价值。ObjectiveTo study preoperative three-dimensional computer reconstruction in hemihepatectomy.MethodsThe clinical data of patients who underwent hemihepatectomy at Affiliated Provincial Hospital of Anhui Medical University from January 2017 to August 2019 was retrospectively analyzed.Of 68 patients,there were 33 males and 35 females.The average age was 60.1 years.Based on whether the patients underwent preoperative three-dimensional computer reconstruction,these patients were divided into the three-dimensional group(n=30)and the control group(n=38).The coincidence rates of preoperative diagnosis by imaging,vascular types and preoperative in relation to intraoperative findings between the two groups were compared.ResultsUsing intraoperative findings as the gold standard,the coincidence rates of preoperative imaging diagnosis of cholelithiasis,hilar cholangiocarcinoma and intrahepatic space occupying lesions were 96.7%(29/30)in the three-dimensional group,and 94.7%(36/38)in the control group.There was no significant difference between the two groups(P>0.05).Using intraoperative or anatomic specimens findings,the coincidence rates of preoperative evaluation of portal vein and bile duct in the three-dimensional group were 93.3%(28/30)and 96.7%(29/30)respectively.The corresponding rates for the control group were 73.7%(28/38)and 79.0%(30/38)respectively.Furthermore,the coincidence rates of liver volume were 96.7%(29/30)in the three-dimensional group and 79.0%(30/38)in the control group.Assessments on portal vein,bile duct and liver volumes were significantly better in the three dimensional group than the control group(P<0.05).ConclusionPreoperative three-dimensional computer reconstruction better diagnosed hilar space occupying lesions and hepatolithiasis,and more accurately delineated vascular courses.All these had important clinical impact on hemihepatectomy.

关 键 词：肝切除术 三维重建 肝门部胆管癌 胆管结石 

分 类 号：R657.3[医药卫生—外科学]