三维可视化技术在联合肝脏分隔和门静脉结扎二步肝切除术中肝中静脉处理的应用价值  

Application value of three⁃dimensional visualization technology in management of middle hepatic vein pro⁃cessing in associating liver partition and portal vein ligation for staged hepatectomy

作　　者：韦明奇 张灵[2] 王继龙 徐邦浩[1] 黄伟琳 滕艳娟[1] 郭雅[1] 彭民浩[1] 文张[1] Wei Mingqi;Zhang Ling;Wang Jilong;Xu Banghao;Huang Weilin;Teng Yanjuan;Guo Ya;Peng Minhao;Wen Zhang(Department of Hepatobiliary Surgery,the First Affiliated Hospital,Guangxi Medical University,Nanning 530021,China;Department of Radiology,the First Affiliated Hospital,Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院肝胆外科,南宁530021 [2]广西医科大学第一附属医院放射科,南宁530021

出　　处：《中华消化外科杂志》2020年第11期1217-1223,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81560387、81902983);广西自然科学基金(2018GXNSFBA050030);广西医疗卫生适宜技术开发与推广应用项目(S2019097、S2018100);广西高校急诊医学重点实验室开放课题(GXJZ201501);广西医科大学第一附属医院“优秀医学英才”科研创新能力培养项目(180327)。

摘　　要：目的探讨三维可视化技术在联合肝脏分隔和门静脉结扎二步肝切除术(ALPPS)中肝中静脉处理的应用价值。方法采用回顾性描述性研究方法。收集2017年11月至2019年8月广西医科大学第一附属医院收治的40例行ALPPS治疗肝右叶巨块型肝癌或多发病灶肝癌患者的临床资料;男34例,女6例;年龄为(44±9)岁,年龄范围为26~64岁。患者术前均行腹上区64层螺旋CT平扫+增强扫描,以1.5 mm薄层图像数据传至IQQA⁃Liver系统,完成肝脏及其血管三维重建。基于三维重建结果结合术中实际情况行ALPPS。观察指标:(1)术前三维重建结果。(2)手术情况。(3)随访情况。采用门诊和电话方式进行随访,了解患者术后生存情况。随访时间截至2020年3月。正态分布的计量资料以x􀭰±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)术前三维重建结果:40例患者均成功行三维重建,其中37例清晰显示肝中静脉、肿瘤位置及两者毗邻关系,3例患者肝中静脉分支显示不清晰,联合二维图像成功将其分型。40例患者肝中静脉分型为A型12例,B型13例,C型9例,D型6例。血管三维重建显示:22例患者有脐裂静脉,9例患者有前裂静脉。40例患者中,35例术前三维重建结果预测保留肝中静脉,5例预测切除肝中静脉。患者术前全肝体积为(1012±119)cm^3,肿瘤体积为600 cm^3(8~2055 cm^3),预留肝脏体积为(346±80)cm^3,剩余肝脏体积/标准肝脏体积为34%±8%。(2)手术情况:40例患者均成功施行ALPPS一期手术,术中35例保留肝中静脉,5例切除肝中静脉,与术前三维重建预测结果一致。34例患者成功施行二期手术,6例因剩余肝脏增生不足未行二期手术。40例患者一期手术时间为(350±79)min,术中出血量为300 mL(100~2600 mL),3例患者接受输血。40例患者均无围术期死亡,一期手术后发生国际肝脏外科学组(ISGLS)标准肝功能不全A级24例,B级16例。Objective To investigate the application value of three⁃dimensional visualization technology in management of middle hepatic vein(MHV)processing in associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).Methods The retrospective and descriptive study was conducted.The clinical data of 40 patients with right massive liver cancer or multiple right liver lesions who underwent ALPPS in the First Affiliated Hospital of Guangxi Medical University from November 2017 to August 2019 were collected.There were 34 males and 6 females,aged(44±9)years,with a range from 26 to 64 years.All patients underwent multi⁃slice computed tomography(CT)plain and enhanced scan of superior abdominal region before operation,and the data were transmitted to the liver visualization analysis software IQQA system with 1.5 mm thin⁃layer images to complete the three⁃dimensional reconstruction of the liver and its blood vessels.Patients were performed ALPPS based on results of three⁃dimensional reconstruction and intraoperative findings.Observation indicators:(1)results of preoperative three⁃dimensional reconstruction;(2)surgical situations;(3)follow⁃up.Follow⁃up was conducted using outpatient examinations and telephone interview to detect postopeartive survival of patients up to March 2020.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were described as M(range).Count data were represented as absolute numbers.Results(1)Results of preoperative three⁃dimensional reconstruction:40 patients underwent three⁃dimensional reconstruction successfully,of which 37 clearly showed MHV,tumor location and relationship between them,3 patients showed unclearly MHV and were classified based on two⁃dimensional images.Of the 40 patients,12 had MHV classified as type A,13 as type B,9 as type C,and 6 as type D.Three⁃dimensional reconstruction of vessels showed 22 with umbilical veins and 9 with anterior veins.Of the 40 patients,35 were predicted to

关 键 词：肝肿瘤 巨块型 联合肝脏分隔和门静脉结扎二步肝切除术 三维可视化技术 肝中静脉 

分 类 号：R735.7[医药卫生—肿瘤]