基于三维可视化技术指导肝多房棘球蚴病手术方案的应用研究  

Research on the application of 3D visualization-based technology to guide surgical plan for hepatic alveolar echinococcosis

作　　者：李振伟[1] 王成[1] 王志鑫[1] 刘津铭 赵乾 王海久[1] 谢智 LI Zhenwei;WANG Cheng;WANG Zhixin;LIU Jinming;ZHAO Qian;WANG Haijiu;XIE Zhi(Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Qinghai University,Xining 810000,Qinghai,China)

机构地区：[1]青海大学附属医院肝胆胰外科,青海西宁810000

出　　处：《中国寄生虫学与寄生虫病杂志》2024年第6期737-743,共7页Chinese Journal of Parasitology and Parasitic Diseases

基　　金：2023年度青海大学青年科研基金(2023-QYY-4);青海省卫生健康委员会(青卫健办[2023] 125号);青海省科学技术厅(青科发规定规[2022] 84号)。

摘　　要：目的 探索三维可视化技术在辅助设计针对肝多房棘球蚴病手术治疗方案中的创新性应用。方法选取2020年1月—2023年3月在青海大学附属医院术前行三维可视化技术的50例肝多房棘球蚴病患者作为研究对象,将患者原始数据传输至人体三维可视化虚拟手术系统,通过三维可视化重建测定全肝体积、预切肝体积、预留肝体积以及棘球蚴病灶体积,计算残肝比,对比术中实际所见,评估三维可视化技术对肝多房棘球蚴病的应用价值。另选择同期未行三维可视化技术的50例肝多房棘球蚴病患者作为对照组,对照组采用二维增强CT影像+精准肝切除。比较两组一般资料及围术期资料,采用广义估计方程模型(GEE)分析患者术后预后的影响因素。结果 两组患者在年龄、性别、体质量指数(BMI)、切除部位、病灶直径、切除肝脏体积、剩余肝脏体积等一般资料,以及在CT特征及MRI等影像学资料的差异均无统计学意义(P> 0.05)。与对照组相比,研究组患者手术时间[(228.56±29.47) min]、Pringle法全肝阻断时间[(26.65±4.78) min]更短,术中出血量[(435.14±98.76) ml]更少,住院时间[(15.27±2.13) d]更短,住院费用[(4.58±0.79)万元]更低,医患沟通满意度(89.65±9.23)更高(t=3.856、3.561、6.069、3.561、5.400、3.812,均P <0.05)。重建的三维模型可进行旋转、缩放、平移等操作,还可以隐藏或者半透明化肝实质、静脉、动脉等结构,可清晰、直观地了解肝脏各重要解剖结构与病灶之间的空间位置关系。三维可视化技术预测的预切肝脏平均体积为2 154.43 ml,预留肝脏平均体积为1 203.27 ml,平均残肝比为41.22%;术中实际切除肝脏平均体积为2 138.75 ml,实际剩余肝脏平均体积为1 193.46 ml。三维可视化重建拟切除肝体积与实际切除肝体积差异无统计学意义(t=1.135,P> 0.05)。GEE分析结果显示,肝多房棘球蚴边缘浸润带有侵犯和三维可视化重�Objective Exploring the innovative application of 3D visualization technology in assisting the design of surgical treatment plans for hepatic alveolar echinococcosis(HAE).Methods Fifty HAE patients who underwent preoperative examination with 3D visualization technology at the Affiliated Hospital of Qinghai University from January 2020 to March 2023 were enrolled to participate the research.The patient’s raw data was transmitted to a human 3D visualization virtual surgical system to process 3D visual reconstruction modeling for determining the whole liver volume,planned liver resection volume,the liver volume to be reserved,and the hydatid lesion volume,thereby,the residual liver ratio was calculated,and compared with what actually seen in the operation to evaluate the application value of 3D visualization technology for HAE.Another 50 patients with HAE who did not undergo 3D visualization technology during the same period were selected as the control group.The control group received 2D enhanced CT imaging and precise liver resection.Compare the general and perioperative data between the two groups were compared and the generalized estimating equation(GEE)model was used to analyze the influencing factors on patients’postoperative prognosis.Results There was no statistically significant difference in general information such as age,gender,body mass index(BMI),resection site,lesion diameter,excised liver volume,remaining liver volume,as well as differences in CT features and MRI imaging data between two groups of patients(P>0.05).Compared with the control group,the study group had shorter surgical time[(228.56±29.47)min],pringle method total liver block time[(26.65±4.78)min],less intraoperative blood loss[(435.14±98.76)ml],shorter hospital stay[(15.27±2.13)days],lower hospitalization costs[(4.58±0.79)yuan],and higher satisfaction with doctor-patient communication(89.65±9.23)(t=3.856,3.561,6.069,3.561,5.400,3.812;all P<0.05).The reconstructed 3D model can be rotated,scaled,and translated,and can also hide o

关 键 词：肝多房棘球蚴病 术前规划 三维可视化技术 预后 

分 类 号：R532.32[医药卫生—内科学]