三维可视化技术结合术中超声在可切除肝癌腹腔镜手术的应用

目的探讨术前应用三维可视化技术结合术中超声实时引导在可切除原发性肝癌腹腔镜手术中应用的近期效果及价值。 方法回顾性分析蚌埠医学院第一附属医院2021年1月至2022年3月行腹腔镜肝切除术的68例原发性肝癌患者资料，根据术前是否行肝脏三维重建及术中超声引导，将患者分为对照组和观察组，各34例。对照组术前增强CT检查后行手术规划，观察组术前在增强CT的基础上采用三维可视化技术进行肝脏三维重建，拟定手术方案，术中行超声实时引导。对比两组患者的手术方式、术中出血量、术中输血比例、肝门阻断时间、手术时间、术后并发症发生率及术后住院时间。 结果与对照组相比，观察组患者术中出血量更少，术中输血比例更低，术中肝门阻断时间、手术时间及术后住院时间更短（均P<0.05）。对照组6例患者中转开腹，两组手术方式比较差异有统计学意义（χ²=4.570，P=0.033）。观察组术后总并发症发生率显著低于对照组（11.8% vs 35.3%，χ²=5.231，P=0.022）。 结论术前三维可视化技术结合术中超声引导在可切除原发性肝癌腹腔镜手术中的应用，有助于制定个体化手术策略，提升临床治疗效果，减少术中出血和肝门阻断时间，降低术后并发症的发生率，对腹腔镜肝切除手术的发展有重要指导意义。

Application of three-dimensional visualization combined with intraoperative ultrasound in laparoscopic surgery for resectable primary liver cancer

ObjectiveTo explore the short-term effect and value of preoperative three-dimensional visualization technology combined with intraoperative ultrasound real-time guidance in laparoscopic surgery for resectable primary liver cancer. MethodsA total of 68 patients with resectable primary liver cancer undergoing laparoscopic hepatectomy in the First Affiliated Hospital of Bengbu Medical College from January 2021 to March 2022 were retrospectively analyzed. According to whether three-dimensional liver reconstruction before operation and intraoperative ultrasound guidance were performed, the patients were divided into the control group (traditional surgical planning after enhanced CT examination) and the observation group (three-dimensional liver reconstruction on the basis of enhanced CT combined with intraoperative ultrasound guidance), with 34 cases in each group. The method of operation, intraoperative blood loss, intraoperative blood transfusion, time of hepatic port blocking, operation time, the incidence of postoperative complications and postoperative hospital stay were observed and compared between the two groups. ResultsCompared with the control group, the patients in the observation group had less intraoperative blood loss, lower proportion of blood transfusion, and shorter intraoperative hepatic port blocking time, operation time and postoperative hospital stay (all P<0.05). Six patients in the control group were converted to open surgery, and the difference between the two groups was statistically significant (χ²=4.570, P=0.033). The incidence of postoperative complications in the observation group was significantly lower than that in the control group (11.8% vs 35.3%, χ²=5.231, P=0.022). ConclusionsThe application of preoperative three-dimensional visualization technique combined with intraoperative ultrasound guidance in laparoscopic resection of primary liver cancer helps to formulate individualized surgery strategies, to improve clinical treatment effects by shortening hepatic port blocking time and reducing intraoperative bleeding and the incidence of postoperative complications. It has important guiding significance for the development of laparoscopic hepatectomy.