【摘要】 目的探讨数字化三维重建技术联合术中B超导航在儿童解剖性肝切除手术中的应用价值。方法通过术前薄层增强CT扫描,对41例肝脏肿瘤患者(观察组)进行数字化三维重建,精确评估肿瘤累及肝叶或肝段与门静脉、肝静脉的毗邻关系,联合术中B超引导肝静脉平面和二级、三级Glisson蒂走行,行解剖性肝切除手术。并与同期22例行传统肝切除手术患者(对照组)的临床资料进行比较。结果观察组术前数字化三维重建图像显示,肝血管位置与术中B超检测结果一致,三维立体图像联合B超在肝脏表面引导静脉走行,能够精确把控切除平面。与对照组相比,观察组术中出血量显著减少(t=2.207,P=0.0311),术后肝脏功能的恢复快(t=2.347,P=0.024),住院时间短(t=2.483,P=0.0158),并发症发生率低(χ~2=7.178,P=0.0074),手术时间相对延长(t=3.781,P=0.004)。结论数字化三维重建技术能做到术前精准评估;结合术中B超导航,可减少儿童解剖性肝切除手术中的出血量,使手术更加安全、精准、有效。更多还原

【Abstract】 Objective To explore the application value of digital three-dimensional reconstruction technology combined with intraoperative B-ultrasound navigation in children’s anatomical liver resection. Methods Preoperative thin-slice enhanced CT scans were performed on 41 children with liver tumors(observation group), and digital three-dimensional reconstruction technology was used to accurately assess the tumor’s involvement of the liver lobe or liver segment in relation to the portal vein and hepatic vein.Combined with intraoperative B-ultrasound navigation, hepatic vein section and second and tertiary Glissonean pedicles were guided to perform anatomical liver resection.These children were compared with 22 children underwent traditional hepatectomy(control group) during the same period. Results The preoperative digital three-dimensional reconstruction image of the observation group clearly showed that the hepatic blood vessels were consistent with the intraoperative B-ultrasound detection.The three-dimensional image combined with B-ultrasound can guide the veins on the liver surface to accurately control the resection plane.Compared with the control group, the bleeding volume of the observation group was significantly reduced(t=2.207,P=0.0311),the postoperative liver function recovered quicker(t=2.347,P=0.024),the incidence of complications was lower, and the hospital stay was shorter(t=2.483,P=0.0158),but the operation time was prolonged(t=3.781,P=0.004). Conclusion Digital 3 D reconstruction technology can achieve accurate preoperative assessment and planning of surgery.It is helpful to combine with intraoperative B-ultrasound navigation for the implementation of anatomical liver resection, thereby reducing bleeding and complications, and making the operation more accurate, safe and effective.更多还原