3D可视化联合3D打印在肝癌大部分肝切除术中的应用

目的:探讨基于3D重建系统软件的肝体积评估和3D可视化、3D打印辅助肝癌大部分肝切除术的应用价值。方法:将符合要求的肝癌行大部分肝切除术患者46例，随机分为观察组和对照组，每组23例。观察组（3D组）患者采用3D可视化技术和3D打印模型进行围手术期规划和指导，主要基于肝体积评估等术前规划和3D可视化分析、3D打印指导肝切除术手术；对照组（CT组）患者采用传统CT资料进行肝体积评估等术前规划、CT二维影像资料指导肝切除术。观察指标:虚拟切除肝体积、实际切除肝体积、残肝体积、标准残肝体积比、手术时间、术中出血量、术后并发症、患者满意度等。结果:3D组与CT组虚拟切除肝体积与实际切除肝体积、虚拟（术前）残肝体积与实际（术后）残肝体积比较，差异均无统计学意义（P>0.05），相关性分析显示虚拟切除肝体积与实际切除肝体积呈正相关性（3D组r=0.990, P<0.001；CT组r=0.943, P<0.001）。3D组与CT组虚拟残肝体积比、实际残肝体积比比较，差异均无统计学意义（P>0.05），且相关性分析显示呈正相关性（3D组r=0.931, P<0.001；CT组r=0.902, P<0.001)。3D组术中出血量少于CT组（P<0.05），3D组患者满意度优于CT组（P<0.05）。两组患者手术时间、术后并发症等比较，差异无统计学意义（P>0.05）。结论:3D重建系统软件和CT软件在评估肝癌大部分肝切除术的肝体积均可行、准确，具有很好的临床应用价值，有助于肝切除术的安全实施。3D可视化联合3D打印在围手术规划可减少手术出血，提高患者满意度，在临床应用中具有潜在优势。

Application of 3D visualization combined with 3D printing in major hepatectomy for liver cancer

Abstract: Objective To explore the application value of liver volume assessment and three-dimensional (3D) visualization based on 3D reconstruction system software and 3D printing-assisted major hepatectomy for liver cancer. Methods Forty-six liver cancer patients scheduled for major hepatectomy were randomly divided into observation group and control group, with 23 cases in each group. 3D visualization technique and 3D printing model were adopted in observation group (3D group) for perioperative planning and guidance which mainly included preoperative planning and 3D visualization analysis based on liver volume assessment and 3D printing-guided liver resection. In control group (CT group), the traditional CT data were used for preoperative planning of liver volume assessment, and the liver resection was guided by two-dimensional CT image data. The observation indexes contained virtual liver resection volume, actual liver resection volume, residual liver volume, standard residual liver volume ratio, operation time, intraoperative blood loss, postoperative complications and patients satisfaction. Results In 3D group and CT group, there were no statistically significant difference in the comparison between virtual liver resection volume and actual liver resection volume, and the comparison between virtual (preoperative) residual liver volume and the actual (postoperative) residual liver volume (P>0.05). There were positive correlations between virtual liver resection volume and actual liver resection volume (r=0.990, P<0.001 in 3D group r=0.943, P<0.001 in CT group). There was no statistically significant difference between virtual residual liver volume ratio and actual residual liver volume ratio in both 3D group and CT group (P>0.05), and there were significant positive correlations between them (r=0.972, P<0.001 in 3D group r=0.931, P<0.001 in CT group). The intraoperative blood loss in 3D group was less than that in CT group (P<0.05), and the patients satisfaction in 3D group was better than that in CT group (P<0.05). No statistical difference was found between two groups in operation time and postoperative complications (P>0.05). Conclusion The use of 3D reconstruction system software and CT software in evaluating the liver volume in major hepatectomy for liver cancer is proved to be effective and accurate, which have good clinical application value and are helpful for the implementation of liver resection. 3D visualization combined with 3D printing can reduce surgical bleeding in perioperative planning and improve patients satisfaction, with potential advantages in clinical application.