三维重建技术在精准肝切除治疗原发性肝癌中的临床应用

Clinical application of 3D reconstruction technique on precise hepatectomy for primary liver cancer

目的评价三维重建技术在原发性肝癌精准肝切除治疗中的临床应用价值。方法应用肝脏三维重建系统(IQQA-Liver)对2011年1月-2012年1月新疆医科大学第一附属医院收治的41例原发性肝癌患者的CT图像数据进行三维重建,进行病灶的定位和分割,评估病灶与肝内管道等信息,完成虚拟手术设计,制定个体化手术方案,指导临床手术。应用三维重建系统及传统二维法分别测量肝脏总体积、病灶体积、预切除肝脏体积、剩余肝脏体积等,将三维重建系统测得各组数据与传统二维测量和术中实际测量的结果进行对比分析,采用t检验、Pearson相关分析检测结果,以统计学散点图表示两者相关性。结果 41例研究对象三维重建模型显示良好,所有患者中,病灶位于右半肝20例;病灶位于左半肝16例。测量肝脏平均总体积为(1 600±486)cm3,病灶平均总体积为(292±247)cm3,预切除肝脏平均体积为(577±288)cm3,剩余占全肝平均体积比为(64.80±11.24)%。术中实际切除肝脏平均体积为(580±285)cm3。采用二维方法计算的结果与采用三维方法计算的结果比较,差异无统计学意义(t=1.835、1.956,P>0.05)。采用三维方法计算预切除肝脏体积越大,术后实际切除肝脏质量越重(r=0.991,P<0.05)。所有患者手术切除方式与术前虚拟手术结果基本一致。结论肝脏三维重建软件在原发性肝癌术前评估中有一定的应用价值,且有利于优化精准肝切除手术方案的选择。

Objective To evaluate the clinical value of three-dimensional reconstruction technique in precise hepatectomy for primary liver cancer. Methods The liver 3D reconstruction system（IQQA-liver） was used to reconstruct CT data of 41 patients with primary liver cancer in our hospital from January 2011 to Januar- y 2012. Volume of total liver volume, tumor volume, predicted resection volume and the remnant liver volume were measured by the software, the data of volume was compared with that were calculated based on the 2-dimensional imaging and actual operation. Results All of the 3D models of liver were reconstruc- ted successfully, the average external volume of liver was（1 600±486） cm3 ; the volume of tumor was （292±247） cm2 ; the predicted resection volume was（577±288） cm3 ; the volume percentage of remnant liver was （64.80±11.24）%. The actual average volume of remnant liver in operation was（580±285） cm3. The volume calculated based on the 2D imaging was similar to that calculated based on the 3D imaging （t = 1. 835, 1. 956, P 〉0.05）. There was a positive correlation between the predicted resection volume and the resected liver volume （r = 0. 991, P 〈0.05）. The surgical methods of patients in actual operation were similar to that in the virtual resection. Conclusion The 3D reconstruction of liver benefits a lot to preoper- ative assessment,and have important significance in precise hepatectomy for primary liver cancer.