智能CT肝切除模型的建立对提高肝细胞癌的规则肝切除临床效果的评估

Evaluation of the clinical effect of the routine hepatectomy after the estabitishment of model of simulating hepatectomy with 256 iCT images

目的研究智能CT(iCT)肝脏三维重建及模拟肝切除模型对临床规则肝切除的指导作用。方法将2008年6月至2009年12月需行根治性肝切除的肝癌患者47例分为iCT组(n=23)和常规组(n=24)。iCT组术前行philips 256层iCT肝脏容积和血管三维重建,并建立模拟临床解剖性肝切除模型,以此模型指导临床行解剖性肝切除;常规组根据二维CT图像采用同样的手术方式行解剖肝切除。结果两组术后输血率无明显差异(P>0.05),但iCT组失血量、输血量和手术耗时均明显少于常规组(P<0.05);iCT组和常规组残肝切缘癌细胞检出率为0%和4.2%;iCT组术后ALT恢复明显优于常规组(P<0.05),总胆红素和AFP的变化无差异(P>0.05);在(8.6±2.3)个月随访期间,iCT组生存率和复发率分别为100%和18.1%,明显优于常规组78.3%和47.8%(P=0.000和P=0.035)。结论建立iCT肝三维重建及模拟精准肝切除模型对临床具有良好的指导作用,有利于提高肝癌肝切除的临床功效。

Objective To study the effect and feasibility of accurate liver resection guided by model of liver three dimensional reconstruction（3D） and model of simulating hepatectomy with iCT images.Methods Forty-seven patients suffered from liver cancer and undergone liver resection,hospitalized from Jun.2008 to Dec.2009 were divided into iCT group（n=23） and routine group（n=24）.Pre-operation,the volume and morphous of total liver were reconstructed with 3D using images of iCT in iCT group patients,and simulating hepatectomy models were built according the principle of liver segments dissection.Liver resection practice was guided by the 3D images and simulating hepatectomy models.Patients in routine group underwent liver resection with two-dimension images.Results Compared with routine group,the volume of intraoperative blood loss,blood transfusion,and operative duration,in iCT group were remarkably less than that in routine group（P0.05）,the rate of blood transfusion was not different（P0.05） between two groups.Recovery of ALT post-operation in iCT group was more better than that in routine group（P0.05）,while the recovery of alpha-fetoprotein（AFP） and total bilirubin（TB） were not different remarkably between the two groups（P0.05）.Patients were followed up from 3~18（12.6±2.3）months.Survival rate of iCT group（100%） was significant higher than that in routine group（78.3%）（P=0.000）;while carcinoma recurrence rate in iCT group（18.1%） was more less than that in routine group（47.8%）（P=0.035）.Conclusion Liver resection for the treatment of hepatocellular carcinoma（HCC）,guided by 3D reconstruction and simulating hepatectomy model,will promote the clinic treating effect of HCC.