3D技术在复杂性肝切除术中的安全性评价

Safety of three-dimensional technique in patients undergoing complicated hepatectomy

目的探讨腹部医学图像三维可视化系统(MI-3DVS)在复杂性肝切除中的诊疗价值。方法因肝癌或肝脏局灶性结节增生而行复杂性肝切除术者共24人,利用MI-3DVS三维重建肝脏、肿瘤、血管等,术前行仿真手术,明确手术可行性;统计分析肿瘤直径、术中出血量、输血量、并发症、住院死亡率及1年生存率等。结果所有患者都安全并成功实施了肝切除术,无围手术期死亡。肝肿瘤直径(9.8±4.3)cm,术中出血量和输血量中位数分别为800和600 ml,输血率91.7%(22/24),住院死亡率0,并发症发生率29.2%(7/24),1年生存率37.5%。结论肝脏容积分析法、剩余肝血流障碍风险评估等3D技术可增加复杂性肝切除手术规划的准确率及手术安全性。

Objective To assess the value of abdominal three-dimensional medical image visualization system （MI-3DVS） in assisting complicated hepatectomy. Methods Twenty-four patients undergoing complicated hepatectomy for hepatic carcinoma or hepatic focal nodular hyperplasia were enrolled in this study. Three-dimensional models of the organs, vessels and tumors were reconstructed with MI-3DVS, and virtual operations were carried out to assess the feasibility of hepatectomy. The diameter of the liver tumors, intraoperative blood loss and transfusion, complications, in-hospital mortality rate, and one-year survival rate were analyzed in these cases. Results The operations were safely completed in all the cases without perioperative deaths. The mean diameter of liver tumor was 9.8±4.3 cm, and the median volumes of intraoperative blood loss and transfusion were 800 ml and 600 ml, respectively, with a blood transfusion rate of 91.7% （22/24）. The incidence of complications was 29.2% （7/24）, and the one-year survival rate was 37.5%. Conclusion Three-dimensional techniques such as volumetric analysis and risk evaluation of residual liver blood supply and drainage can increase the accuracy of surgical planning and improve the safety of complicated hepatectomy.