多模态影像技术在巨块型肝癌精准手术治疗中的应用  

Application of multimode imaging technology in precise hepatectomy for huge hepatocellular carcinoma

作　　者：刘文瑛 欧阳再兴 朱剑华 吴黎明 谭勇 宋灏 朱玉珍 黄从云 LIU Wenying;OUYANG Zaixing;ZHU Jianhua;WU Liming;TAN Yong;SONG Hao;ZHU Yuzhen;HUANG Congyun(Department of Hepatobiliary Surgery,Yuebei People's Hospital of Shantou University Medical College,Shaoguan,Guangdong 512025,P.R.China)

机构地区：[1]汕头大学医学院附属粤北人民医院肝胆外科,广东韶关512025

出　　处：《中国普外基础与临床杂志》2022年第9期1207-1212,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：2021年度韶关市科技计划项目(项目编号:210805174532225);2021年度韶关市卫生健康科研项目(项目编号:Y21128)。

摘　　要：目的 探讨多模态影像技术在巨块型原发性肝癌精准手术治疗中的临床应用价值。方法 回顾性收集2018年1月至2020年12月期间粤北人民医院肝胆外科行多模态影像技术指导下精准肝切除术治疗的巨块型原发性肝癌患者的临床病理资料,使用三维重建、三维可视化、三维打印、增强现实指导术前评估、手术规划和手术导航,分析患者手术方式、手术时间、术中出血量、切除肝体积、术后住院时间、并发症、术后肝功能、血常规、凝血功能等情况。结果 本研究共23例患者,其中男18例、女5例,年龄(56.8±8.1)岁。多模态影像技术虚拟评估的肿瘤体积为(865.2±165.6)mL,虚拟切除肝体积为(1 628.8±144.4)mL,规划的手术方式为解剖性肝切除19例,非解剖性肝切除4例;实际实施的手术方式有17例行解剖性肝切除术、6例行非解剖性肝切除术,与增强现实结果基本一致。23例患者均顺利完成手术,实际切除肝脏体积为(1 648.5±163.6)mL,Pearson相关性分析结果显示其与虚拟切除肝体积基本一致(r=0.910,P<0.001)。手术时间为(298.4±74.5)min,中位入肝血流阻断时间为20 min,术中出血量为(330.4±152.8)mL。与术前比较,血红蛋白和白蛋白水平在术后第1天呈一过性降低(P<0.05),从术后第3天开始上升且基本在正常范围内;凝血酶原时间、总胆红素、丙氨酸氨基转移酶及天门冬氨酸氨基转移酶均在术后第1天呈一过性升高(P<0.05),之后开始下降且基本达到正常水平。未发生严重手术并发症,无围术期死亡。中位随访时间18个月,3例出现肿瘤复发、转移。结论 本研究的初步结果提示,通过多模态影像技术进行精准的术前评估和实时指导肝切除术,可提高巨块型原发性肝癌精准手术的精准性和安全性。Objective To study clinical practical value of multimode imaging technique in precise hepatectomy for huge hepatocellular carcinoma(HCC). Methods The clinicopathologic data of patients with huge HCC who underwent precise hepatectomy in Yuebei People’s Hospital from Jan. 2018 to Dec. 2020 were collected. The threedimensional(3D) reconstruction, 3D visualization, 3D printing, and augmented reality(AR) were used to guide preoperative evaluation, surgical planning, and surgical navigation. The liver function indexes, surgical mode,operative time, intraoperative bleeding, volume of resected liver, postoperative hospitalization, and complications were analyzed. Results There were 23 patients in this study, including 18 males and 5 females, with(56.8±8.1) years old. The virtual tumor volume assessed by multimodal imaging technology was(865.2±165.6) mL and the virtual resected liver volume was(1 628.8±144.4) mL. The planned operations were anatomical hepatectomy in 19 patients and non-anatomical hepatectomy in 4 patients. The actual operation included 17 cases of anatomical hepatectomy and 6 cases of non-anatomical hepatectomy, which was basically consistent with the results of AR. The operative time was(298.4±74.5) min, the median hepatic blood flow blocking time was 20 min, and the intraoperative bleeding was(330.4±152.8) mL. Compared with preoperative levels, the levels of hemoglobin and albumin decreased temporarily on the first day after operation(P<0.05),and then which began to rise on the third day and basically rose to the normal range;prothrombin time, total bilirubin,alanine aminotransferase, and aspartate aminotransferase increased transiently on the first day after operation(P<0.05),then which began to decline to the normal levels. There were no serious operative complications and no perioperative death. The median follow-up time was 18 months, the tumor recurrence and metastasis occurred in 3 cases.Conclusion From preliminary results of this study, it could improve surgical safety and precision of hep

关 键 词：三维成像 三维打印 增强现实 巨块型肝癌 精准肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]