三维重建仿真肝切除系统指导肿瘤右半肝切除手术中的临床应用

目的评价三维重建及仿真肝切除系统用于肿瘤右半肝切除的临床价值。方法回顾性分析2017年1月至2018年5月福建医科大学附属协和医院收治的原发性肝癌行右半肝手术24例患者的临床资料。将病例随机分2组,三维重建组14例,对照组10例。观察手术时间、术中出血量、术后肝功能不全、术后并发症和术后住院时间。结果两组手术顺利,术中无大出血等并发症。术后三维重建组均无发生肝功不全、肝衰竭、胆汁漏等并发症;对照组中仅1例发生术后一过性肝功能不全。患者手术时间三维重建组为(54.9±5.7)min,对照组为(73.7±7.3)min;术中出血量三维重建组为(124.3±25.2)mL,对照组为(248.0±65.9)mL;术后ALT三维重建组为(124.3±25.2)U/L,对照组为(411.1±95.7)U/L;术后住院时间三维重建组为(6.6±2.2)d,对照组为(8.5±1.9)d,差异均有统计学意义(均P<0.05)。结论三维重建及仿真肝切除系统可以准确重建肝内脉管走行及其与肿瘤的三维关系,精确计算剩余肝脏体积和肿瘤体积,为肿瘤右半肝切除手术方案的制定提供了可靠依据,降低了术中和术后并发症的发生,缩短了患者的术后住院时间。对肿瘤右半肝切除的应用具有重要的临床价值。

Clinical application of three-dimensional reconstruction and hepatectomy simulation system in guiding right hemihepatectomy for tumor

Objective To evaluate the clinical value of three-dimensional reconstruction and hepatectomy simulation system in guiding right hemihepatectomy for tumor.Methods A retrospective analysis was made in 24 patients with primary hepatocellular carcinoma who underwent right hemihepatectomy from January 2017 to May 2018 in our hospital.These cases were randomly divided into 2 groups,14 cases in three-dimensional reconstruction group and 10 cases in control group.The operation time,intraoperative blood loss,postoperative liver dysfunction,postoperative complications and hospitalization time after operation were recorded.Results The 2 groups successfully completed the operation without intraoperative complications such as massive hemorrhage.No complications such as hepatic dysfunction,hepatic failure,bile leakage occurred in three-dimensional reconstruction group after operation.In control group,only 1 case had transient hepatic insufficiency after operation.The operation time and postoperative hospitalization time were significantly shorter in three-dimensional reconstruction group than those in control group(54.9±5.7)minutes vs.(73.7±7.3)minutes,(6.6±2.2)days vs.(8.5±1.9)days].The intraoperative blood loss was significantly less in three-dimensional reconstruction group than that in control group(124.3±25.2)ml vs.(248.0±65.9)ml].And the postoperative alanine aminotransferase level was significantly lower in three-dimensional reconstruction group than that in control group(124.3±25.2)U/L vs.(411.1±95.7)U/L].Conclusion Three-dimensional reconstruction and hepatectomy simulation system can accurately reconstruct the course of intrahepatic vessels and its anatomical relationship with tumors,and accurately display residual liver volume and tumor volume.It provides a reliable basis for surgical design of right hemihepatectomy for tumor,reduces the occurrence of intraoperative and postoperative complications,and shortens the hospitalization time of patients after operation.It has important clinical value for right hemihepatectomy for tumor.