末梢门静脉栓塞联合多模态影像技术在巨大肝癌外科治疗中的应用  

Clinical application value of terminal branches portal vein embolization and multimode imaging technology in precise hepatectomy of huge hepatocellular carcinoma

作　　者：刘文瑛 阙园 欧阳再兴 朱剑华 吴黎明 谭勇 宋灏 朱玉珍 黄从云 LIU Wenying;QUE Yuan;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,Shaoguan,Guangdong 512025,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 [2]广东医科大学研究生院,广东湛江524023

出　　处：《实用医学杂志》2023年第12期1546-1550,共5页The Journal of Practical Medicine

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

摘　　要：目的探讨末梢门静脉栓塞技术和多模态影像技术在巨大肝癌外科手术中的应用价值。方法回顾性分析2018年2月至2021年11月肝胆外科收治的使用多模态影像技术指导的52例巨大肝癌患者临床资料,根据治疗方式分为直接手术切除组(对照组,27例)和末梢门静脉栓塞术序贯手术切除组(研究组,25例)。多模态影像技术融合三维重建、可视化、3D打印、增强现实技术,进行术前评估、手术规划和手术导航;末梢门静脉栓塞技术彻底阻断两侧肝脏间门静脉系统交通支,促进剩余肝脏体积(FLR)增生后行手术治疗。观察分析两组患者围手术期情况如手术方式、手术时间、术中出血量等,以及疗效如并发症、复发或转移情况等。结果52例患者均成功完成多模态影像技术指导下的术前评估、手术规划和术中导航,研究组患者末梢门静脉栓塞术后FLR获不同程度增生93~322 cm^(3),中位增生体积183 cm^(3)。所有患者均顺利完成手术,未发生围手术期死亡。术后均未发生严重并发症如出血、胆漏、肝功能衰竭等。研究组入肝血流阻断时间、术中出血量、术后住院时间、术后并发症发生率分别为(27.6±11.6)min、236(100)mL、(10.8±2.4)d、12.0%(3/25),明显少于对照组的(34.4±10.9)min、292(150)mL、(13.1±4.1)d、37.0%(10/27),差异有统计学意义(P<0.05)。研究组和对照组手术时间分别为(209.6±36.5)、(237.0±69.1)min,差异无统计学意义(P>0.05)。研究组和对照组术后复发或转移各5、11例,两组复发差异无统计学意义(χ^(2)=0.735,P>0.05)。结论末梢门静脉栓塞技术和多模态影像技术通过增加剩余肝脏体积、精准术前规划和手术导航,可提高巨大肝癌外科手术治疗的安全性和手术效果。Objective To evaluate the clinical application of the terminal branches portal vein embolization and multimode imaging technology in precise hepatectomy for patients with huge hepatocellular carcinoma.Methods Clinical data of 52 patients of huge hepatocellular carcinoma underwent precise hepatectomy with the help of multimode imaging technology in Yuebei People′s Hospital between Feb.2018 and Nov.2021 were retrospectively analyzed.According to the treatment method,the patients were divided into direct surgical resection group(control group,27 cases).And terminal branches portal vein embolization followed by surgical resection group(study group,25 cases).The multimode imaging technology fusing three⁃dimensional reconstruction which convert⁃ed from CT imaging,three⁃dimensional visualization,three dimensional printing and augmented reality in assess⁃ing the hepatic anatomy,instructing preoperative planning and navigating operation.The terminal branches portal vein embolization technology blocked the interconnected portal vein of the two sides of the liver,and promoted the future liver remnant before surgery.Perioperative results and postoperative efficacy of the two groups such as the surgical methods,operative time,intraoperative blood loss,and postoperative complications were observed and analyzed.Results The multimode imaging technology were successfully applied in all 52 patients,achieved satis⁃fying preoperative assessment,surgical planning,and intraoperative navigation.The future liver remnant of patients in the study group were promoted effectively,(93~322 mL,media183 mL).All patients underwent surgery suc⁃cessfully,there were none perioperative death,no serious postoperative complications such as bleeding,biliary leakage and liver failure occurred.The hepatic blood flow occlusion time,intraoperative blood loss,postoperative length of stay and the incidence of postoperative complications of the study group were(27.6±11.6)min,236(100)mL,(10.8±2.4)d,12.0%(3/25),respectively.Significantly less th

关 键 词：巨大肝癌 末梢门静脉栓塞 三维可视化 3D打印 增强现实 精准肝切除 

分 类 号：R735.7[医药卫生—肿瘤]