三维数字成像手术计划系统在精准肝切除术中的应用

目的:探索三维数字成像手术计划系统在肝切除术中的应用。方法:采用三维手术计划系统(Myrian)用于临床精准肝切除。2015年1月至2018年1月,95例肝癌患者,其中传统手术组67例采用传统肝切除,手术的设计、规划和实施都是基于传统的二维图像。3D组28例均采用三维数字成像手术计划系统指导下的精准肝切除。比较两组手术时间、出血量、住院时间和并发症。结果:(1)术前三维手术系统预估的病灶切除体积与术后肝脏实际切除体积差异无统计学意义(P>0.05);(2)3D组患者术后胸腔积液、胆漏、肺部感染、切口感染、肝衰竭的发生率以及1年生存率分别为5.26%、0、1.75%、2.6%、0、92.31%,传统手术组分别为8.9%、1.49%、4.47%、2.98%、1.49%、78.85%,两组差异无统计学意义(P>0.05)。3D组肿瘤复发率(7.69%)低于传统手术组(15.38%)(P<0.05);(3)传统手术组患者术中出血量、术后住院时间、手术时间、肝血管阻断时间、围手术期死亡病例数为(628.5±124.4)mL、(11.4±4.3)d、(117.1±32.4)min、(38.4±10.2)min、1例,3D组分别为(416.7±83.8)mL、(7.6±2.4)d、(178.5±40.9)min、(48.3±12.7)min、0例,两组差异有统计学意义(P<0.05)。结论:三维重建技术对肝癌患者术前评估有利于术者优化、选择精准肝切除手术方案。

Application of three-dimensional digital imaging surgical planning system in precise hepatectomy

Objective:To explore the application and advantages of a three-dimensional digital imaging surgical planning system in hepatectomy.Methods:Our hospital introduced three-dimensional surgical planning system(Myrian),which can be used for clinical accurate hepatectomy.From January 2015 to January 2018,the clinical data of 95 patients with liver cancer admitted to the Second Affiliated Hospital of Xi'an Jiaotong University were selected.Among them,67 patients in the traditional operation group were treated with traditional hepatectomy.The design,planning and implementation of the operation were based on the traditional two-dimensional image.28 cases in 3D group were treated with precise hepatectomy under the guidance of 3D digital imaging operation planning system.In this study,the intraoperative and postoperative conditions of the traditional operation group,such as operation time,bleeding volume,hospitalization time and complications,were statistically analyzed and compared with the relevant data of the 3D group;Myrian system was used to calculate the whole liver volume,standard liver volume,tumor volume,pre resected liver volume,and remaining liver volume of 3D group patients,and the weight of actual resected liver and sample volume were measured during the operation to test the accuracy of the volume of liver to be resected.Results:(1)there was no significant difference(t=0.52,P>0.05)between the estimated volume of focus resection and the actual volume of liver resection;(2)the incidence and 1-year survival rate of pleural effusion,bile leakage,lung infection,incision infection,liver failure in 3D group were 5.26%,0,1.75%,2.6%,0,92.31%respectively,compared with that in traditional operation group,8.9%,1.49%,4.47%,2.98%,1.49%,78.85%respectively,there was no significant difference between the two groups(P>0.05).The recurrence rate of 3D group was 7.69%lower than that of traditional operation group 15.38%(P<0.05);(3)In the traditional operation group,there were 628.5±124.4mL,11.4±4.3 d,117.1±32.4 min,38.4±10.2 min in bleeding volume,postoperative hospitalization time,operation time,hepatic vascular occlusion time,and perioperative death cases.In the 3D group,there were 416.7±83.8 mL,7.6±2.4 d,178.5±40.9 min,48.3±12.7 min and 0 cases,respectively.There was significant statistical difference between the two groups(P<0.05).Conclusion:Three dimensional reconstruction technology can produce significant benefits for preoperative evaluation of patients with liver cancer,and is conducive to the optimization and selection of accurate hepatectomy.