计算机辅助手术规划系统在精准肝切除中的应用价值

Application of computer-assisted operation planning system in precise hepatectomy

目的评价计算机辅助手术规划系统在精准肝切除中的临床应用价值。方法回顾性分析2006年11月至2009年11月解放军总医院对45例肝癌患者通过计算机辅助手术规划系统进行精准肝切除治疗的临床资料。术前通过计算机辅助手术规划系统进行肝脏三维重建，对肝脏血管结构及其与肿瘤的解剖关系进行二维和三维分析；分别计算肝段体积、肿瘤体积、全肝体积、预切除肝脏体积和剩余肝脏体积，切除标本术后称重并与预切除肝脏体积比较；实施虚拟肝切除，优化手术方案。采用t检验、Pearson相关分析、z。检验分析检测结果。结果术前预切除肝脏体积采用二维方法计算的结果与采用三维方法计算的结果比较，差异无统计学意义（t=2．125，P〉0．05）。计算机辅助手术规划系统能够清晰显示肝动脉、门静脉和肝静脉等血管结构的三级分支，对肿瘤与毗邻血管的空间解剖关系进行量化分析，精确测算血管所支配的功能体积，当预测的切除肝脏体积越大，切除标本质量越大（r=0．999，P〈0．05），误差率为5．1％。全组患者均进行了解剖性肝切除，手术并发症发生率为20％（9／45），均通过保守治疗好转。术后无肝功能衰竭发生，无围手术期死亡。结论计算机辅助手术规划系统能够优化手术方案，是开展精准肝切除的有益辅助工具。

Objective To investigate the clinical value of computer-assisted operation planning system for precise hepatectomy. Methods The clinical data of 45 patients who had undergone precise hepatectomy at General Hospital of PLA from November 2006 to November 2009 were retrospectively analyzed. The 3-dimensional imaging of liver was constructed by computer-assisted operation planning system, and the anatomic relationship between hepatic vasculature and tumor was analyzed. Volume of hepatic segments, total liver volume, tumor volume, predicted resection volume and the remnant liver volume were calculated before operation. Virtual liver resection was performed in order to select the best operative procedure. The predicted resection volume was compared with the hepatic segment resected. All data were analyzed by t test, Pearson rank correlation analysis and chi-square test. Results The predicted resection volume calculated based on the 2-dimensional imaging was similar to that calculated based on the 3-dimensional imaging （ t = 2. 125, P 〉 0.05 ）. The three-grade branches of the hepatic artery, portal vein and hepatic vein were clearly shown in the computer-assisted operation planning system. The anatomic relationship between tumor and adjacent vessels was quantitatively analyzed. There was a positive correlation between the predicted resection volume and the resected liver volume （ r = 0. 999, P 〈 0.05 ）, and the error rate was 5.1%. All patients received anatomical hepatectomy, and the incidence of postoperative complications was 20% （9/45）. No liver failure or perioperative mortality was observed. Conclusion Computer-assisted opera- tion planning system may facilitate and promote precise hepatectomy.