【摘要】 目的:探讨数字化三维重建技术在肝癌精准肝切除术中的临床应用。方法:选择2015年10月—2017年10月收治的21例原发性肝癌(肿瘤直径>5cm)患者,术前行肝脏CT平扫加增强检查,利用Myrian三维重建软件对肝脏进行三维重建处理,对患者肝内血管,肿瘤位置、大小及两者的毗邻关系进行分析,计算全肝体积(TLV)、标准肝体积(SLV)、功能性肝体积(FLV)、肿瘤体积(Tu V)、拟切除肝体积(v RLV)、拟切除标本体积(v RSV)及残肝体积(RLV),并测量术中实际切除标本重量(a RSW)及标本体积(a RSV),检验v RSV的准确性并对v RSV、a RSV及a RSW进行相关性分析。结果:21例患者TLV为(1827.9±314.8)cm~3,Tu V为(593.4±283.2)cm~3,v RLV为(511.2±180.0)cm~3,v RSV为(1104.6±292.3)cm~3。术后测量a RSW为(1212.9±278.46)g,用排水法测量a RSV为(1101.0±280.4)cm~3。v RSV与a RSV比较无统计学意义(P=0.76)。Pearson相关性分析显示a RSV与v RSV、a RSW与v RSV、a RSW与a RSV之间呈高度正相关(r=0.9964、0.9201、0.9345,均P<0.0001)。术前虚拟手术方案与实际手术方案均吻合,术后21例均未出现肝性脑病及肝功能衰竭,围手术期无病例死亡。结论:术前行肝脏三维重建结合肝功能评估,对肿瘤精确定位、自动化分割、定量分析,特别是肝体积计算和虚拟肝切除术对肝癌精准肝切除术的手术方案选择有重要价值。更多还原

【Abstract】 Objective: To investigate the clinical application of digital three-dimensional reconstruction technique in precise hepatectomy for liver cancer. Methods: Twenty one patients with primary liver cancer(tumor diameter >5 cm) treated from October 2015 to October 2017 were selected. All patients underwent plain and contrast enhanced CT scan of the liver before operation. Three-dimensional reconstruction of the liver was performed by Myrian reconstruction software. The intrahepatic vessels,location and size of the tumor and their relationship in the patients were analyzed,and the total liver volume(TLV),standard liver volume(SLV),functional liver volume(FLV),tumor volume(Tu V),virtual resection liver volume(v RLV),virtual resection specimen volume(v RSV) and residual liver volume(RLV) were calculated. The intraoperative actual specimen weight(a RSW) and actual specimen volume(a RSV) were determined. After that,the accuracy of v RSV was examined and analyzed and the correlations among v RSV,a RSV and a RSW were analyzed.Results: In the 21 patients,the TLV was(1 827.9±314.8) cm~3,Tu V was(593.4±283.2) cm~3,v RLV was(511.2±180.0) cm~3 and v RSV was(1 104.6±292.3) cm~3; the a RSW obtained after operation was(1 212.9±278.46) g. There was no significant difference between v RSV and a RSV(P=0.76). Pearson test showed that there were significantly positive correlation between a RSV and v RSV,a RSW and v RSV and a RSW and a RSV(r=0.9 964,0.9 201,0.9 345,all P<0.0 001). The preoperative virtual surgery simulations were consistent with the actual surgical protocols. None of the 21 patients had hepatic encephalopathy or liver failure after operation,and no death occurred during the perioperative period.Conclusion: The three-dimensional reconstruction of liver combined with liver function assessment before operation has great value for surgical procedure selection of precise liver cancer resection,for its precise tumor positioning,automatic segmentation and quantitative analysis,especially liver volume calculation and virtual liver resection.更多还原