三维可视化技术在肝胆管结石诊断和手术规划中的应用研究

目的探讨三维可视化技术在肝胆管结石的诊治及手术规划中的临床应用价值。方法选取南方医科大学珠江医院肝胆外科2012年6月至2014年2月收治的40例肝胆管结石病病人的临床资料。应用腹部医学图像三维可视化系统（Mb3DVS）对CT图像进行三维重建，根据重建模型中结石与肝内外胆管的情况，进行术前个体化诊断，肝脏个体化分段及体积计算，以及设计手术方案并进行术前演练，并用以指导真实手术。结果40例肝胆管结石病人均完成三维重建，包括Ⅰ型10例，Ⅱa型18例，Ⅱb型8例，Ⅱc型4例，合并胆总管结石23例。3D图像可清晰观察肝脏、结石及“胆管树”立体形态。40例病人术前三维重建与术中所见符合率、术前手术规划与实际手术符合率均一致，其中3例病人经二次硬镜取石术，最终达到无结石残留。所有病人术中无胆管损伤、大出血、胆漏、急性胰腺炎等并发症发生。结论术前应用三维可视化对肝胆管结石病病人进行诊断和手术规划，可有效减少肝胆管结石病人手术的并发症及术后残石率。

Application of three-dimensional visualization in the diagnosis and surgery planning of hepatolithiasis

Objective To assess the value of three-dimensional （3D） visualization technique in the preoperative diagnosis and surgery planning for hepatolithiasis. Methods A total of 40 patients of hepatolithiasis were recruited during June 2012 to February 2014. Their imaging data of computed tomography （CT） were entered into medical image three-dimensional visualization system （MI-3DVS） for 3D reconstruction. And 3D models were employed to make individualized 3D classifications and diagnoses. Individualized liver segments were used for surgical planning. Results Among them, the classifications were type Ⅰ （n = 10）, type Ⅱ a （n = 18）, type Ⅱ b （n = 8）, type Ⅱ c （n = 4） and type E （n = 23）. The 3D models delineated liver, stone, biliary system and blood vessels. Total consistency existed between surgical and preoperative findings based on 3D model and also between actual surgical procedures and preoperative simulations （n = 40）. Three patients were reoperated. The final stone clearance rate was 100%. Conclusions For hepatolithiasis patients, applying 3D visualization in the di- agnosis and surgery planning may effectively reduce operative complications and residual stone rate.