三维手术模拟系统在巨大肝癌精准肝切除中的应用

Application of a operation planning system for precise hepatectomy in patients with giant hepatocellular carcinoma

目的探讨三维手术模拟系统在巨大肝癌精准肝切除中的应用价值。方法回顾性分析2009年5月至2011年5月中山大学附属第一医院收治的34例因巨大肝癌行精准肝切除患者的临床资料。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，分别计算模拟切除肝脏体积，手术切缘距离等，将模拟值与术后实际值进行比较。两者间比较采用t检验，模拟值与实际值的相关性检验采用Pearson等级相关分析。结果全组患者行精准肝切除术。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。模拟切除肝脏体积和手术切缘距离分别为（2112±1550）ml和（12±6）mm，实际切除肝脏体积和手术切缘距离分别为（2031±1411）ml和（12±6）mm，模拟值与实际值具有相关性（r=0．961，0．923，P〈0．05），两两比较，差异均无统计学意义（t=1．549，1．143，P〉0．05）。所有患者手术并发症经保守治疗后好转，术后元肝功能衰竭或死亡患者。结论三维手术模拟系统可准确评估患者肝脏情况和模拟肝脏手术，在巨大肝癌精准肝切除的术前评估中可起到一定的辅助作用。

Objective To evaluate the feasibility of a three-dimensional （3D） operation planning system for precise hepatectomy in patients with giant hepatoeellular carcinoma （HCC）. Methods The clinical data of 34 patients with giant HCC who received precise hepatectomy at the First Affiliated Hospital of Sun Yat-sen University from May 2009 to May 2011 were retrospectively analyzed. Preoperative evaluation was done based on the computed tomography data, and the resection margin and the volume of resected liver were calculated using simulation. The predicted resected liver volume and resection margins were compared with the results of the actual operations. All data were analyzed using the t test, and the correlation between predicted and the actual values was analyzed by calculating Pearson correlation coefficients. Results Hepatic and tumor tissues and the hepatic vessels were reconstructed three-dimensionally using the 3D preoperative simulation software. The volume of simulated resected liver and the length of resection margin were （2112±1550）ml and （12± 6）mm, respectively, while the volume of actual reseeted liver and the length of resection margin were （2031 ±1411 ）ml and （12 ± 6）mm, respectively. The predicted and the actual values were statistically correlated （ r = 0. 961, 0. 923, P 〈 0.05 ）. There was no significant difference between the predicted and the actual values （ t = 1. 549, 1. 143, P 〉 0.05 ）. All patients received precise hepatectomy, and no hepatic failure or death was observed. Conclusion The 3D operation planning system can accurately evaluate the condition of the liver and simulate hepateetomy, and could contribute to safer and more curative precise hepatectomy in patients with giant HCC.