三维可视化评估技术在肝脏尾状叶肿瘤手术治疗中的应用

目的 探讨肝脏三维可视化评估技术在精准肝切除手术术前规划中的应用价值。方法 回顾性分析2015年4月—2016年12月东方肝胆外科医院肝外三科采用精准肝切除手术治疗的75例尾状叶肝肿瘤患者的临床资料,其中男55例、女20例,年龄30~66岁,均采用肝脏三维可视化技术进行术前规划,并应用术前三维重建模型模拟肝脏尾状叶肿瘤切除手术。对比术前规划与术中操作,计算全肝体积、模拟切除肝体积、剩余功能性肝体积,统计全组患者手术方式、手术时间、肝血流阻断时间、术中出血量、术中输血量等,并统计术后并发症。结果 模拟切除肝体积263.89 mL(33.76,1 650.85),剩余功能性肝体积1 189.67 mL(529.79,1 859.72)。行单独尾状叶肿瘤切除27例,左半肝+尾状叶切除6例,部分右肝(Ⅵ、Ⅶ段)+尾状叶切除14例,右半肝+尾状叶切除20例,中肝叶(Ⅳ、Ⅴ、Ⅷ段)+尾状叶切除8例。75例患者均完整切除肿瘤,第一肝门阻断时间数25(0,62)min,出血量300(100,3 600)mL,手术时间198(116,388)min,输血11例,输血量600(200,3 000)mL。患者术中均未发生大出血、空气栓塞。术后发生并发症29例,其中Ⅰ类并发症1例,经剖腹探查止血后顺利恢复,余患者均顺利出院。术后随访有1例患者因消化道出血死亡。结论 采用肝脏三维可视化评估技术进行术前精准规划,可使术者更准确地掌握切除范围,规避主要血管,控制术中出血,以及维持术后肝功能。

Application of three-dimensional visualization technology in surgical resection of caudate lobe tumor

Objective To evaluate the precision of hepatectomy by preoperative planning of preoperative liver three-dimensional visualization.Methods Seventy-five patients with caudate lobe liver tumor underwent preoperative three-dimensional visualization surgery planning. Preoperative planning and intraoperative operation were compared. Total liver volume, normal liver volume and residual functional liver volume were calculated, method of hepatectomy, duration of operation, time of occlusion, volume of bleeding, transfusion and the postoperative complications were recorded.Results The preoperative three-dimensional reconstruction model was used to simulate surgical resection. The volume of liver resection was 263.89 mL (33.76,1 650.85), and the residual functional liver volume was 1 189.67 mL (529.79,1 859.72), 27 patients received caudate lobe liver resection only, 6 patients received left plus caudate lobe resection, 14 patients received partial right(Ⅵ, Ⅶ section) plus caudate lobe resection, 20 patients received right plus caudate lobe resection, 8 patients received middle(Ⅳ, Ⅴ and Ⅷ section) plus caudate lobe resection, Pringle's maneuver 25(0,62)min, bleeding 300(100,3 600)mL, operating duration 198(116,388)min, 11 patients receive blood transfusion,amount of transfusion 600(200,3 000)mL. All patients successfully performed tumor resection according to preoperative planning. There were no massive hemorrhage and air embolism in the patients. One case of ISGLS I complications after operation were successfully recovered after caesarean section, and all the remaining patients were discharged from hospital smoothly.Conclusions With accurate preoperative planning, the resection range can be accurately mastered, the main vessels are avoided, intraoperative bleeding and the maintenance of postoperative liver function can be controlled.