3D打印模型联合吲哚菁绿荧光导航行腹腔镜下精准肝切除术

目的 探讨三维（three-dimensional，3D）打印模型联合吲哚菁绿（indocyanine green，ICG）荧光导航在腹腔镜下精准肝切除术中的临床应用价值。方法 基于CT数据建模，采用镂空技术1:1 打印出1 例肝内胆管结石的3D肝脏模型，进行术前规划，并联合ICG荧光导航行腹腔镜下精准肝切除术。回顾性分析手术方案的制定及术中、术后临床资料。结果 基于3D打印肝脏模型，手术方案从肝V/VIII段切除改为肝V段切除。3D打印模型与肝内结构吻合，可直视肝内复杂管道，联合ICG术中导航顺利完成腹腔镜下精准肝切除术。手术时间约210 min，其中肝切除时间约100 min，术中出血量约50 mL，术中无输血。术后无腹腔出血、腹腔感染、胆漏等并发症。结论 采用3D打印肝脏模型联合ICG荧光导航为腹腔镜下精准肝切除术提供了一种新技术。

Application of 3D printing model combined with indocyanine green fluorescence navigation in the laparoscopic precise hepatectomy

Objective To explore the clinical value of application of three-dimensional (3D) printed model combined with indocyanine green (ICG) fluorescence navigation in the laparoscopic precise hepatectomy. Methods Based on CT data modeling, one 3D liver model of intrahepatic bile duct calculi was printed 1:1 by hollowed out technology for preoperative planning and laparoscopic precise hepatectomy, which was performed in combination with ICG fluorescence navigation. The formulation of surgical protocols, as well as intraoperative and postoperative clinical data were retrospectively analyzed. Results Based on 3D printed liver model, operative plan changed from V/VIII segmental hepatectomy to just V segmental resection. The 3D printed model was consistent with the intrahepatic structure, enabling direct vision of the complex intrahepatic vessels and bile ducts. Laparoscopic precise hepatectomy was performed successfully by 3D printed model combined with indocyanine green fluorescence navigation. The operation time was about 210 min, of which the liver resection time was about 100 min. The intraoperative blood loss was about 50 mL and there was no intraoperative blood transfusion. There were no complications such as abdominal hemorrhage, abdominal infection or bile leakage. Conclusion 3D printed liver model combined with ICG fluorescence navigation provides a new technique for the laparoscopic precise hepatectomy.