三维手术模拟系统在肝癌患者精准肝切除中的应用

Validation and Application of Novel Three Dimensional Operation Planning System in Patients with Hepatocellular Carcinoma Requiring Precise Hepatectomy

目的评价一种新研发的三维手术模拟系统在精准肝切除中的应用价值。方法回顾性分析2009年5~11月期间在中山大学附属第一医院肝胆外科因肝癌接受精准肝切除术的85例患者的临床资料。对所有患者术前行CT检查,应用三维手术模拟系统进行术前评估,分别计算模拟切除的肝脏体积、剩余肝脏体积和手术切缘,并与术后实际切除肝脏体积和实际手术切缘进行比较,最后通过软件虚拟肝切除功能优化手术方案。结果 三维手术模拟系统可以清晰地显示和三维重建正常肝脏组织、肿瘤组织和肝内血管。所有患者均行精准肝切除术,3例患者术后2 d出现腹水,2例患者术后2 d出现中量胸水,4例术后5 d发现漏胆,均经保守治疗后好转。85例患者住院时间为6~88 d（平均23 d）,术后30 d内无复发,住院期间无死亡病例。患者模拟切除肝脏体积与实际切除肝脏体积统计学上具有相关性（r=0.960,P〈0.001）,两者均值的差异无统计学意义（896.7 ml比819.1 ml,t=1.851,P=0.068）。模拟手术切缘与实际手术切缘统计学上也具有相关性（r=0.972,P〈0.001）,两者均值的差异也无统计学意义（12.2 mm比11.9 mm,t=1.143,P=0.256）。结论 三维手术模拟系统可准确评估和模拟肝脏手术情况,在精准肝切除的开展中具有一定的辅助作用。

Objective To evaluate the feasibility and accuracy of a novel three dimensional（3D） preoperative simulation software in a clinical setting for patients undergoing precise hepatectomy.Methods The clinical data of 85 patients with hepatocellular carcinoma underwent precise hepatectomy were retrospectively studied.All the patients received CT screening and subsequent evaluation on the liver resection volume and margin and the percentage of resected tumor by 3D preoperative simulation software,which compared with the actual resection liver values.The operation plan was optimized by virtual hepatectomy.Results The liver,tumor as well as blood vessel could be clearly showed and reconstructed by 3D preoperative simulation software.All the patients underwent precise hepatectomy.After operation ascites occurred in 3 patients on 2 d,moderate pleural effusion occurred in 2 patients on 2 d,and bile leakage appeared in 4 patients on 5 d,which were improved by conservative treatment. The length of stay in all patients ranged from 6 to 88 d（mean 23 d）,and no recurrence and death occurred within 30 d of operation.The predicted resection liver volume was significantly correlated with the actual resection volume（r=0.960,P〈0.001）,and the difference between the mean volume of predicted and actual resection liver was not significant（896.7 ml vs.819.1 ml,t=1.851,P=0.068）.In addition,the predicted resection margin was also correlated with the actual resection margin（r=0.972,P〈0.001）,with the difference in the mean resection margin was not significant too（12.2 mm vs.11.9 mm,t=1.143,P=0.256）.No patients suffered from severe postoperativecomplications.Conclusions The 3D preoperative simulation software is able to evaluate and simulate liver resection accurately,which may contribute to a safe precise hepatectomy plan.