螺旋CT三维成像在小儿巨大及复杂部位肝脏肿瘤诊治中的应用

Use of three-dimensional computerized tomography reconstruction in giant liver tumors in children

目的应用螺旋CT三维成像辅助、指导小儿巨大肝脏肿瘤和复杂部位肝脏肿瘤的诊断及手术治疗。方法对近5年来肝脏巨大和位于肝门的复杂部位肝脏肿瘤18例进行分析、总结。10例使用螺旋CT三维成像检查,以辅助指导手术的具体操作。结果18例中肝右叶切除7例,右三叶切除3例,肝左叶3例,多发性1例,左三叶1例,3例为肝门部肝中叶或扩大肝中叶切除。其中肝母细胞瘤9例、畸胎瘤1例、肝细胞癌2例、肝腺瘤2例、错构瘤4例。10例三维成像者均获得清晰的肿瘤瘤体和与血管比邻关系的图像。16例行超过肝脏体积三分之一的肝叶切除,最大者切除瘤肝达4800g。全组成功手术切除,均康复出院。结论通过动态三维立体的画面,特别是可以旋转的动态影像能清楚显示血管的走行、位置。对手术方案的选择、制定、肝脏切线的选择都提供很大的帮助。

Objective To assess the role of the three-dimensional reconstruction with spiral CT for the guidance of diagnosis and operation in giant liver tumors in children. Methods Clinical data of 18 cases with giant liver tumors or with tumors in the middle lobe during last 5 years were retrospectively analyzed. Among them, 10 cases were examined by the three-dimensional reconstruction using 16 slice spiral CT. Results The volume of removed lobes exceeded half of the liver in 16 cases. The biggest removed liver with tumor was 4 800 g. Among them, 7 tumors located in the right lobe, 3 in the left lobe, 3 in the middle lobe, 3 exceed the right lobe,2 exceed the left lobe. Pathological diagnoses included hepatoblastoma （9）, hepatocellular carcinoma （2）, mesenchymal hamartoma （4）, teratoma （1） and adenoma （2）. All patients scopic margins, No major intra- or got the curative resections as indicated by ＂tumor-free＂ micropostoperative complications were encountered. The location, range, and relationship to the adjacent vessels of tumors had been clearly demonstrated by the three-dimensional computed tomography reconstruction in these 10 patients. Conclusions CT three-dimensional imaging can provide high quality images of the tumors and clearly demonstrate the relationship between tumor and the adjacent blood vessels. It would play an important role in the diagnosis and guidance for resection of giant liver tumor in children.