摘要
目的:探讨术前三维重建技术在大范围肝切除中的应用价值。方法:回顾性分析2016年1月~2018年6月泰州市人民医院总院收治的45例行大范围肝切除(≥4个肝段)肝癌患者的临床资料,所有患者术前均行薄层CT检查,应用三维重建系统(IQQA-Liver)进行术前评估,充分显示肿瘤与肝脏血管的关系,并行手术模拟规划,分别计算肝脏体积、模拟手术肝切除体积、剩余肝脏体积、手术切缘等。并与手术中实际切除肝脏体积及切缘对比。结果:45例患者三维重建后均能清晰显示肝脏、肝内外血管、肿瘤、肿瘤与肝脏血管关系。患者术前模拟切除肝脏体积(845.2+285.5)m L,实际切除肝脏体积(826.3±268.1)m L,两者比较差异无统计学意义(t=0.425,P>0.05)。模拟手术切缘(11.2±3.4)mm,实际切缘(10.6±2.8)mm,两者比较差异无统计学意义(t=0.471,P>0.05)。此两项指标术前模拟与手术实际均呈正相关性(r=0.95,P<0.01;r=0.83,P<0.01)。结论:三维重建技术能够清晰显示肝脏肿瘤与肝脏脉管的关系,准确评估肝切除的体积及手术切缘,在大范围肝切除术中具有一定的临床应用价值。
Objective To explore the value of three-dimensional reconstruction technology in the preoperative assessment of hepatocellular carcinoma(HCC)patients treated with extensive hepatectomy.Methods The clinical data of 45 HCC patients undergoing extensive hepatectomy(≥4 segments)in Jiangsu Taizhou People’s Hospital between January 2016 and June 2018 were analyzed retrospectively.All the patients underwent thin-slice CT examination before operation,and three-dimensional reconstruction system(IQQA-Liver)was used for preoperative assessment.The relationship between tumor and hepatic blood vessels was fully displayed in preoperative assessment;and then the operation procedure was simulated for calculating liver volume,removed liver volume,residual liver volume and surgical margin.The simulated liver volume and surgical margin were then compared with the actual surgical results.Results The liver tissues,hepatic vessels,tumor,and the adjacent relationship of tumor and hepatic vessels of 45 patients were clearly displayed after three-dimensional reconstruction.There was no significant difference between the removed liver volume in simulation and the actually removed liver volume[(845.2+285.5)mL vs(826.3±268.1)m L;t=0.425,P>0.05],between simulated surgical margin and actual margin[(11.2±3.4)mm vs(10.6±2.8)mm;t=0.471,P>0.05)].Both the two above-mentioned indexes in simulation were positively correlated with the actual operation(r=0.95,P<0.01;r=0.83,P<0.01).Conclusion Three-dimensional reconstruction technology can clearly show the relationship between hepatic tumor and hepatic vessels,accurately evaluate the hepatic volume and surgical margin of liver resection,with certain clinical value in extensive hepatectomy.
作者
杨兴业
王林俊
陈曦
周红兵
袁寅
YANG Xingye;WANG Linjun;CHEN Xi;ZHOU Hongbing;YUAN Yin(Department of Hepatobiliary and Pancreatic Surgery,Jiangsu Taizhou People's Hospital,Taizhou 225300,China;Department of General Surgery,Jiangsu Province Hospital,Nanjing 210029,China)
出处
《中国医学物理学杂志》
CSCD
2020年第5期625-628,共4页
Chinese Journal of Medical Physics
关键词
肝癌
三维重建
大范围肝切除
肝脏体积
手术切缘
hepatocellular carcinoma
three-dimensional reconstruction
extensive hepatectomy
liver volume
surgical margin
