三维重建技术联合持久美蓝染色法在精准解剖性肝切除术中的应用

Application of three-dimentional reconstruction technique and methylene blue staining in precise anatomic hepatectomy

目的评价三维重建技术联合持久美蓝染色在精准解剖性肝切除术中的临床价值。方法回顾性分析2009年2月至2011年8月解放军总医院收治的12例肝细胞癌患者的临床资料。术前常规行CT或MRI增强扫描检查，并将所得数据进行三维重建，立体评估肝脏肿瘤的门静脉供血及其与毗邻脉管的空间解剖关系。随后采用持久美蓝染色技术行精准解剖性肝切除术。结果三维重建所确定的肿瘤所在门静脉区域及其与相应肝蒂解剖关系的准确性为12／12，美蓝染色后的目标肝段与三维重建肝段的形状相符。本组行扩大半肝切除术2例，肝叶切除术3例，肝段（亚段）切除术5例，联合肝段切除术2例。12例患者肿瘤平均直径为5．6cm（2．5～16．0cm），平均手术时间为（150±24）min，术中平均出血量为（236±25）ml，术后平均住院时间为（10±3）d，术后并发症发生率为2／12。所有患者平均随访14个月，2例患者出现肿瘤肝内复发，其中1例死于肿瘤进展。结论采用三维重建技术有助于精确评估肝脏肿瘤与毗邻脉管的解剖关系，联合持久肝脏染色的方法可显著提高解剖性肝切除术的精准性。

Objective To evaluate three-dimentional （3D） reconstruction technique and methylene blue staining in precise anatomic hepatectomy. Methods The clinical data of 12 patients with hepatocellular carcinoma who were admitted to the Chinese PLA General Hospital from February 2009 to August 2011 were retrospectively analyzed. The 3D reconstruction of the liver tumor and intrahepatic vessels were done based on the computed tomo- graphy data and magnetic resonance imaging data. The portal vein supplying the tumor and its anatomic relation- ship with adjacent vessels were evaluated. Precise anatomic hepatectomy was performed guided by sustained meth- ylene blue staining. Results The accurate rate of 3D model of the portal triad was 12/12. The shape of target segments observed after methylene blue staining was consistent with the resuhs of 3D evaluation. Two patients received hemihepatectomy, 3 received lobectomy, 5 received monosegmentectomy or subsegmenteetomy, 2 received muhisegmentectomy. The mean tumor diameter, operation time, blood loss, postoperative hospital stay and complication rate were 5.6 cm （2.5-16.0 cm） , （ 150 ± 24） minutes, （236 ± 25 ） ml, （ 10 ±3 ） days and 2/12, respectively. After a median follow-up of 14 months, tumor recurrence was found in 2 patients, and 1 of them died of tumor progression. Conclusions The 3D reconstruction may contribute to precise evaluation of the anatomic relationship between the tumor and its adjacent vessels. The 3D technique combined with sustained methylene blue staining may significantly improve the accuracy of anatomic hepatectomy.