三维可视化技术在评估残肝体积及指导肝切除中的应用研究

目的研究三维可视化技术在肝脏肿瘤术前评估及指导精准肝切除中的临床应用。方法采集10例入住我院的肝脏肿瘤患者术前64排螺旋CT亚毫米原始扫描数据,再运用腹部医学图像三维可视化系统(MI-3DVS)进行图像分割及三维重建,观察重建模型进而仿真手术,计算残肝体积百分比,结合患者临床资料评估手术风险,将仿真手术与真实手术全过程,术前风险评估及真实预后情况进行对比分析。结果 MI-3DVS对腹部脏器及其脉管系统三维重建的模型结构清晰、直观、形象逼真。10例患者功能肝体积介于(1335.28±293.72)ml;肿瘤体积介于(399.06±276.26)ml;残肝体积介于(770.12±226.77)ml;结合患者临床资料,10例患者术前测得的残肝体积百分比均能满足术后肝功代偿要求,仿真手术与真实手术全过程一致,术前利用MI-3DVS手术风险评估与真实手术风险一致。结论三维可视化技术对指导肝脏肿瘤手术方案的制定,提高肝脏肿瘤切除率,评估手术风险,降低手术并发症的发生率意义重大。

Study on the application of three-dimensional visualization technique in evaluation of residual liver volume and guidance for hepatectomy

Objective To assess the clinic value of three-dimensional(3D) visualization technique in preoperative evaluation and guidance for precise liver resection in patients with hepatic tumors.Methods 10 inpatients with hepatic tumors were enrolled into the study.The original submillimeter scanning data captured by 64-slice spiral CT scanner were collected.Then the data were imported into three dimensional medical imaging virtual system(MI-3DVS) and segmentation and three-dimensional reconstruction were performed.The reconstructed three-dimensional models were observed and the simulation surgery were implemented.The calculation of the percentage of remnant liver volume and the assessment of surgical risk were carried out,combined with patients’ clinical data.Further,The comparative analysis of the whole process of the simulation process and real surgery,the preoperative risk assessment and the real prognosis were respectively made.Results The reconstructed three-dimensional models of the abdominal organs and vascular systems by MI-3DVS were clear,intuitive,visual and vivid.In 10 patients,the volume range of normal functional liver tissue was(1335.28±293.72) ml;tumor volume:(399.06±276.26) ml;remnant liver volume:(770.12±226.77) ml;combining with patients’ clinical data,10 patients’ percentage of residual liver volume measured preoperatively can meet the requirements of postoperative liverdecompensation,the process of the simulation and real operation were consistent,so were surgical risk preoperatively assessed using MI-3DVS and real operation risk.Conclusion 3d visualization technique makes a great significance in guidance for liver resection planning and elevating the resection rate of hepatic tumors,assessing operative risk and decreasing postoperative complications.