【作者】 李留峥； 王峻峰； 徐雷升； 俸家伟； 王志萍； 高学昌； 龚国茶； 于杰；

【Author】 Li Liuzheng;Wang Junfeng;Xu Leisheng;Feng Jiawei;Wang Zhiping;Gao Xuechang;Gong Guocha;Yujie;Department of hepatobiliary surgery, Lincang people’s Hospital;The first people’s Hospital of Yunnan Province;

【机构】 云南省临沧市人民医院肝胆外科； 云南省第一人民医院；

【摘要】 目的:探讨三维可视化技术辅助解剖性肝切除术的应用价值。方法:回顾性分析2016年1月～2017年12月行三维可视化技术辅助解剖性肝切除术78例肝肿瘤及肝胆管结石患者的临床资料,对肝脏CT数据的采集、三维重建方式、解剖性肝切除方法进行总结分析。术前采用Slicer软件进行虚拟肝切除,借助三维可视化分析系统对肝脏进行三维重建和三维可视化分析,计算功能肝体积、肝肿瘤体积、残肝体积等,分析肝脏解剖、制定手术规划及解剖性肝切除方案。其中原发性肝癌55例,胆管细胞癌5例,肝门部胆管癌6例,胆囊癌5例,巨大肝血管瘤4例,复杂肝内胆管结石3例。78例均完成解剖性肝切除术,其中Ⅰ段切除3例,Ⅰ+Ⅱ+Ⅲ+Ⅳ段切除3例,Ⅰ+Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ段切除1例,Ⅰ+Ⅳb+Ⅴ段切除3例,左半肝(Ⅱ+Ⅲ+Ⅳ段)切除16例,Ⅱ+Ⅲ+Ⅳ+Ⅷ段切除1例,Ⅱ+Ⅲ+Ⅴ+Ⅵ+Ⅶ+Ⅷ段切除1例,左三叶(Ⅱ+Ⅲ+Ⅳ+Ⅴ+Ⅷ段)切除3例,Ⅳb+Ⅴ段切除5例,Ⅳ+Ⅴ+Ⅷ段切除3例,右三叶切除(Ⅳ+Ⅴ+Ⅵ+Ⅶ+Ⅷ段)3例,右半肝切除(Ⅴ+Ⅵ+Ⅶ+Ⅷ段)23例,右前叶(Ⅴ+Ⅷ段)切除5例,右后叶切除术(Ⅵ+Ⅶ段)4例,Ⅷ段切除4例。其中2例同时行肝管空肠Roux-Y吻合术。结果:78例患者均完成了三维可视化图像重建,术前虚拟肝切除术,虚拟切除肝体积为(1020±264)m L。全组采用三维可视化技术辅助完成了解剖性肝切除术,手术时间(210±54)min,术中出血量(671±231)m L,术后住院时间(18.5±3.2)d,术后并发症率15.4%,围手术期死亡1例,实际切除肝体积(1125±267)m L。结论:三维可视化技术有助于精确判断肿瘤侵犯血管、胆管的情况,确定安全性的肝切除量和范围,优化手术方案,提高解剖性肝切除术的疗效。更多还原

【Abstract】 Objective To explore the application value of three-dimensional visualization technology in anatomic hepatectomy. Method TOretrospectively analyz the clinical data of 78 patients with liver tumor and hepatolithiasis from January 2016 to December2017,then summarize and analyse the data collection, three-dimensional reconstruction and anatomical hepatectomy of liver CT.Slicer software was used to perform virtual hepatectomy and three-dimensional visualization analysis system was used to analyze the liver volume, liver tumor volume and residual liver volume. The liver anatomy, operation planning and anatomical liver resection were analyzed.Among them, there were 59 cases of primary liver cancer, 5 cases of cholangiocarcinoma, 2 cases of hilar cholangiocarcinoma, 5 cases of gallbladder carcinoma, 4 cases of hepatic hemangioma and 3 cases of intrahepatic bile duct stones. 78 cases were all performed anatomic hepatectomy.Among them, there were 3 cases ofⅠsegment resection, 3 cases ofⅠ+Ⅱ+Ⅲ+Ⅳ segment resection, 1 cases of I +Ⅱ+Ⅲ+Ⅳ+V+Ⅷ segment resection, 3 cases of Ⅰ+Ⅳb+V segment resection, 16 cases of left half liver(Ⅱ+Ⅲ+Ⅳ segment) resection, 1 cases of Ⅱ+Ⅲ+Ⅳ+Ⅷ segment excision, 1 Ⅱ+Ⅲ+V+Ⅵ+Ⅶ+Ⅷ segment excision, 3 left Trifolium(Ⅱ+Ⅲ+Ⅳ+V+Ⅷ segment) resection, 5 cases of Ⅳb+V segment resection, 3 cases of Ⅳ+V+Ⅷ segment excision and right Trifolium. 3 cases of excision(Ⅳ+V+ Ⅵ+Ⅶ +Ⅷ), 23 cases of right hemi hepatectomy(V+ Ⅵ+Ⅶ +Ⅷ segment), 5 cases of right anterior lobe(V+Ⅷ segment) resection, 4 cases of right posterior lobectomy(Ⅵ+Ⅶ segment), and 4 cases of Ⅷ segment excision,and 2 cases of Roux-Y anastomosis of the hepatic duct and jejunum at the sametime.Result All 78 patients completed the 3 D visual reconstruction. Preoperative virtual liver resection and virtual hepatectomy volume were(1020+264)ml.The whole group was assisted by three-dimensional visualization technique to complete anatomical hepatectomy, the operation time(210+54) min, intraoperative bleeding(671+231) m L, postoperative hospital stay(18.5+3.2)d, postoperative complication rate 15.4%, perioperative death 1 cases, and actual resection of liver volume(1125+267)ml.Conclusion Three-dimensional visualization technique helps to accurately determine the situation of tumor invasion of blood vessels and bile ducts, determine the amount and scope of safe hepatectomy, optimize the operation plan, and improve the curative effect of anatomical hepatectomy.更多还原