3D可视化技术联合术中门静脉穿刺染色在解剖性肝段肝切除中的应用  

Application and safety of three-dimensional visualization technique plus intraoperative dyeing during anatomical liver resection

作　　者：管加福 樊友文 周兵海 余新[1] 袁荣发[1] 吴华俊[1] 胡志刚[1] 王恺[1] Guan Jiafu;Fan Youwen;Zhou Binghai;Yu Xin;Yuan Rongfa;Wu Huajun;Hu Zhigang;Wang Kai(Department of Hepatobiliary Surgery,Second Affiliated Hospital,Nanchang University,Jiangxi Nanchang 330006,China;Department of General Surgery,Seventh Affiliated Hospital,Sun Yat-sen University,Guangdong Shenzhen 518107,China)

机构地区：[1]南昌大学第二附属医院肝胆胰外科,江西南昌330006 [2]中山大学附属第七医院普通外科,广东深圳518107

出　　处：《腹部外科》2021年第4期280-284,共5页Journal of Abdominal Surgery

基　　金：国家自然科学基金(82060454)。

摘　　要：目的通过3D可视化技术进行手术方案制定并联合术中门静脉穿刺染色进行解剖性肝切除术,以提高解剖性肝切除的成功率及安全性。方法运用3D可视化技术重建病人肝脏及血管虚拟模型,明确病人病灶所在肝段或者亚肝段的门静脉血供,根据重建结果制定手术方案,并利用虚拟模型指导术中超声引导下向目标门静脉注射亚甲蓝或吲哚菁绿染色标记切除范围,根据染色范围精准切除肿瘤所在肝段或亚肝段。结果共21例病人运用该方法制定手术方案,其中原发性肝癌17例,肝胆管结石病4例,21例病人术中成功穿刺目标肝段或亚肝段的供血门静脉,其中19例(90.5%)染色效果满意,2例(9.5%)染色未达到预期效果,1例存在反流,但反流区域较目标染色区域显影淡,1例染色区域部分覆盖相邻肝段,通过结合术中超声定位段间肝静脉确定了目标肝段的边界。最终所有病人均通过手术顺利切除病灶及其所在肝段或亚肝段。21例病人平均手术时间为245.7 min(165~355 min),平均出血量为276.2 mL(100~600 mL),术中平均输血量为1.2 U(0~4 U),术后平均住院时间为10.8 d(6~20 d)。结论运用3D可视化技术制定手术方案并模拟穿刺手术切面,可降低术中穿刺染色的技术难度,保证解剖性肝脏切除的完成。Objective To improve the accuracy and reliability of anatomical liver resection through surgical planning by three-dimensional(3D)visualization technology plus intraoperative puncturing and injecting of dye.Methods The model of liver and blood vessel in 21 patients was established with 3D reconstruction for determining portal vein blood supply of involved hepatic segment or subsegment.Surgical planning was based upon the result of 3D reconstruction and portal vein punctured.Methylene dye was injected for marking the size of lesions and hepatic segment or subsegment.Then precise resections were performed.Results There were tumors(n=17)and hepatolithiasis(n=4).Portal veins supplying blood to target hepatic segment or sub-hepatic segment were successfully punctured.The outcomes were satisfactory(n=19,90.5%)and non-satisfactory(n=2,9.5%).In one case of regurgitation,regurgitation area was weaker than target staining area.In another case of adjacent hepatic segmental staining,the boundary of target liver segment was successfully marked by combining with intraoperative ultrasound.All lesions and hepatic or subhepatic segments were successfully excised.Mean operative duration,incidence of blood loss,red blood cell transfusion and postoperative hospital stay were 245.7(165-355)min,276.2(100-600)mL,1.2(0-4)U and 10.8(6-20)days respectively.Conclusion Using 3D visualization for preoperative planning and simulating puncture section may reduce the difficulty of puncturing and dye injecting of dye and ensure the completion of anatomical resection.

关 键 词：3D可视化技术 美蓝染色 解剖性肝切除 

分 类 号：R657.3[医药卫生—外科学]