虚拟肝脏手术规划应用于肝切除术的研究

Study on virtual liver surgery planning applied to hepatic resection

目的探讨虚拟肝脏手术规划对肝切除术的指导价值。方法基于患者螺旋CT断层图像，应用自主研发的虚拟肝脏手术规划系统软件Liv 1．0对2007年5月至2009年5月收治的142例肝肿瘤患者进行虚拟肝脏手术规划，将虚拟手术规划结果与手术中所见进行对比。结果（1）重建的142例三维可视化肝脏效果满意，清晰显示肝肿瘤的大小、位置、数目及其与肝内管道的空间毗邻关系，并可从任意角度观察，与术中所见匹配良好。（2）通过虚拟肝脏手术规划，可显示肝切除过程中需切除或保留的肝内管道，计算出余肝组织可能出现缺血和淤血的范围；通过反复的手术模拟，改变手术切除界限，优化手术方案。其中29例经CT图像判断无法切除而应用该系统进行手术规划后完整切除肿瘤，92例经虚拟手术后优化了手术方案。（3）127例肝癌患者虚拟肝脏手术规划所测预切除肝脏体积为（477±223）ml，实际切除肝脏体积为（451±209）ml，误差率为6．1％，两者间呈正相关（R=0．922，P〈0．01）。结论应用软件Liv 1．0进行肝脏三维重建及虚拟肝脏手术规划可以为复杂的肝切除术提供重要的术前参考，有利于提高手术预见性和安全性，有利于提高复杂性肝切除的成功率。

Objective To evaluate the impact of preoperative three-dimensional visualization and virtual liver surgery planning on hepatic resection. Methods All relevant structures （ livers, portal vein, hepatic veins,and tumors） were extracted from muhislice CT scans of 149 cases treated from May 2007 to May 2009. By the liver surgery planning system software Liv 1.0, reconstruction and image analysis of the relevant structures was performed and virtual resections of liver were carried out. Data were correlated to intraoperative findings. Results （1） Three-dimensional visualization revealed the spatial relationship of tumors to the intrhepatic vascular system, thus giving impressions how the neoplasms were situated. Virtual tumor resections corresponded to the intraoperative findings. （2） With the planning, an intended resection could be performed virtually and optimal identification of resection margins could be achieved. The ischemia and congestion territory within the remaining liver parenchyma could be calculated. Simulation resections could avoid liver parenchyma over resection and maintain a sufficient amount of liver tissue to sustain hepatic function. Virtual simulations of tumor resection were used successfully to plan of surgical procedures in the hepatic tumors. Hepatectomy was performed in 29 cases after virtual tumor resections but seemed impossible with conventional CT scan. Resection p｜ans of 92 cases were optimized after virtual resections. （3） The mean liver volume of patients with primary hepatocellular carcinoma measured by the software and the real resected was （477 ±223） ml and （451 ±209） ml respectively. Comparison by means of linear regression analysis between volume measurement on the software and the real resected showed a nearly ideal correlation coefficient （ R = 0. 922,P 〈 0. 01 ） . The mean error was 6. 1%. Conclusions The three-dimensional tumor visualization and virtual simulation of tumor resections of the software Liv 1.0 provide an important reference for a valuable planning of complex hepatic resections. It is not only benefit to improve the predictability and security of hepatectomy but also helpful to improve the success rate of complex hepatic resections.