肝脏影像解读分析系统在精准肝切除手术规划中的应用

Value of Computer Assisted Radiology and Surgery Solutions System in Surgical Planning for Precise Hepatectomy

目的探讨肝脏影像解读分析系统在精准肝切除手术规划中的意义。方法回顾性分析我院2012年1月1日至2013年6月30日期间完成的95例精准肝切除患者的临床资料,术前均经肝脏影像解读分析系统进行三维定量分析及模拟手术设计。结果 95例患者经肝脏CT影像解读分析系统重建,得到了清晰的肝脏、肿瘤和肝内脉管系统的三维图像并可任意角度旋转观看,可以显示距肿瘤2 mm、5 mm、10 mm、20 mm等不同肿瘤切缘时可能累及并需切除的主要血管及该血管支配的肝脏区域体积。全肝体积为(1 776.4±998.5)cm3,拟切除肝体积为(1 026.2±811.5)cm3,肿瘤体积为(589.3±496.8)cm3,功能性残余肝脏体积为(795.3±522.6)cm3。功能性残余肝脏体积与标准化全肝体积的比值为(58.2±25.1)%,其中无肝硬变患者其比值均>30%,肝硬变患者其比值均>40%。本组95例均实施精准肝脏切除手术操作,根据残余肝体积量、功能等因素综合考虑手术方案,其中9例缩小了切除范围,4例扩大了切除范围,无围手术期死亡病例。结论肝脏影像解读分析系统可精确定位肝脏肿瘤,计算残余的功能性肝脏体积,明确肿瘤邻近的血管解剖关系,最终辅助设计最优化的手术方案。

Objective To investigate the value of computer assisted radiology and surgery solutions system （IQQA- Liver） in surgical planning for precise hepatectomy. Methods The clinical data of 95 cases performed precise hepatec- tomy from January 1, 2012 to June 30, 2013 in our hospital were retrospectively analyzed, and the computer assisted radiology and surgery solutions system was used for three dimensional quantitative analysis, volume measurement and designing for liver resection in all the cases before operation. Results The intuitive and clear three dimensional images of all the 95 cases were obtained by using the computer assisted radiology and surgery solutions system, which could show the precise anatomical relationship of the liver, tumor, and main hepatic vascular. The three dimensional images could be observed at any angle and rotated freely, and could show the involved and needed to be resected vascular away from the tumor margin for 2 mm, 5 ram, 10 mm, and 20 mm and the liver volume dominated by this vascular. Of all the 95 cases, the total liver volume was （1 776.4±998.5） cm3, the proposed removed liver volume was （1 026.2±811.5） cm3, the functional residual liver volume was （795.3 ± 522.6） cm3. The ratio of functional residual liver volume to the standard total liver volume was （58.2±25.1） %, which the ratio of patients without cirrhosis was 〉30% and with cirrhosis was 〉40%. All the 95 cases were implemented precise operation. The operation plan was designed based on a combination of factorssuch as the amount of functional residual liver volume and function. The surgery programs were changed for 13 cases, in which 9 cases were narrowed the scope of resection and 4 cases were expanded the scope of resection. No patients died perioperation. Conclusion By using the computer assisted radiology and surgery solutions system （IQQA-Liver）, we could precisely locate liver tumor, calculate the functional residual liver volume, identify the relationship between tumor and adjacent vascular, and ultimately help to design the optimal surgical plan.