3D虚拟手术规划系统在精准肝切除治疗肝细胞癌中的临床应用

目的 探讨3D虚拟手术规划技术对精准肝切除治疗肝细胞癌的指导价值.方法 回顾性分析16例肝细胞癌患者通过3D虚拟手术规划系统（IQQA-Liver）辅助下进行肝切除的临床资料,术前使用IQQA-Liver对患者薄层CT图像进行三维重建,对病灶定位和分割,评估病灶与肝内管道等信息,并分别计算标准肝脏体积、肿瘤体积、预切除肝脏体积、剩余肝脏体积和残肝体积百分比,从3D影像学角度完成术前评估和手术方案设计,制定个体化手术方案,并与术后实际切除肝脏体积进行比较.结果 使用IQQA-Liver对肝脏进行三维重建的模型结构清晰、直观、形象逼真.所有手术患者术后残肝体积均能得到准确评估,确保代偿,住院天数4～11 d（平均7d）,未出现肝衰及胆漏等并发症,住院期间无死亡病例,16例患者模拟手术预切除体积与实际手术切除的肝脏体积具有明显相关性,平均误差率约6.3％.结论 IQQA-Liver可在术前准确模拟肝脏切除手术情况,对制定精准肝切除手术方案有指导作用.

3D virtual surgery planning system in clinical application of precise liver resection for hepatocellular carcinoma

Objective To evaluate the clinical application of 3D technology in treatment of precise hepatectomy.Methods The clinical data of 16 patients with hepatocellular carcinoma who underwent precise hepatectomy assisted by 3D virtual surgery planning system （IQQA-Liver） were retrospectively analyzed.3D virtual surgery planning system （IQQA-Liver） was used to rebuild in three dimensions for thin layer CT image,the lesion location and segmentation and assessment of lesions and intrahepatic duct and other information.Furthermore,the author calculated the standard liver volume,size of tumor,resection of liver volume,residual liver volume and residual liver volume percent by 3D virtual surgery planning system.Through the 3D imaging perspective,the author completed preoperative assessment and the design of individual operation plan,and compared these with the actual removal of postoperative liver volume.Results The figure of liver model established by 3D virtual surgery planning system were clear,intuitive and vivid.The residual liver volumes of all patients were accurate assessed.The hospital stay was a period ranging from 4 to 11 days （average,7 days）.All cases were alive and didn＇t appear complications such like the liver failure,bile leakage and others.Simulated surgery for resection volume and the actual surgical resection of liver volume has obvious relevance in 16 patients and the average error rate of about 6.3％.Conclusions 3D virtual surgery planning systems could accurate simulation the operation status and guide the liver resection surgery planning.