数字化三维重建系统在肝泡型包虫病治疗中的应用

Application of a digital three-dimensional reconstruction technique in the diagnosis and treatment of hepatic alveolar echinococcosis

目的探讨数字化三维重建系统在肝泡型包虫病（HAE）治疗中的应用价值。方法采用数字化三维重建系统对2011年2月至10月新疆医科大学第一附属医院收治的13例HAE患者的肝脏CT检查数据进行三维重建及智能分析，术前评估可切除陛，设计合理的手术方案，完成术前个体化虚拟手术，并与术中实际情况作比较。结果13例患者CT检查数据三维重建结果满意，肝内病灶及相关管道关系显示清晰。1例患者行体外肝切除＋自体肝移植术，10例行肝切除术，2例行PTCD，与虚拟手术设计方案一致。术前通过三维重建系统对11例拟行手术的患者进行虚拟手术设计，测得预切除肝脏平均体积为920ml（339—2678m1）；切除肝脏体积占全肝体积平均为45％（23％-68％）。患者实际切除肝脏平均体积为834ml（315—2250m1）；术中切除肝脏体积占全肝体积平均为42％（22％～70％），与术前三维重建结果基本一致。术后随访2—8个月，所有患者未出现肝功能衰竭、出血、胆汁漏等严重并发症。结论数字化三维重建系统有助于确定HAE合理的手术方式，有效降低了手术风险。

Objective To investigate the value of a digital three-dimensional reconstruction technique in the treatment of hepatic alveolar echinococcosis （HAE）. Methods The computed tomography scan data for 13 patients with HAE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from February 2011 to October 2011 were reconstructed and analyzed by a three-dimensional reconstruction system to assess resectability, and to facilitate surgical planning and individualized virtual surgery. The results of preoperative analysis were compared with the results of actual operations. Results The three-dimensional models of the liver were reconstructed successfully, and intrahepatie lesions and vessels were clearly displayed. One patient received an autologous liver transplantation, 10 underwent hepatectomy, and 2 received percutaneous transhepatic cholangial drainage. Virtual operation planning was carried out for 11 patients using the three-dimensional reconstruction system. The mean volume of the liver to be resected was predicted to be 920 ml （range, 339-2678 ml）, and the mean percentage of liver to be resected to the total liver volume was predicted to be 45% （range, 23%-68% ）. The mean volume of the actual liver resection was 834 ml （range, 315-2250 ml）, and the mean percentage of actual liver resected to the total liver volume was 42% （range, 22% -70% ） , which was consistent with the results of preoperative three-dimensional reconstruction. All patients were followed up for 2-8 months, and no severe complications such as liver failure, hemorrhage and bile leakage were detected. Conclusion Digital three-dimen- sional reconstruction is helpful in the diagnosis and treatment of HAE and effectively reduces surgical risks.