三维可视化重建在复杂肝血管瘤精准肝切除中的应用

Application of three-dimensional visualization system for precise hepatectomy in patients with complicated hepatic hemangiomas

目的 探讨三维可视化系统在复杂肝血管瘤精准肝切除中的应用价值.方法 回顾性分析2012年10月至2013年10月收治的12例因复杂肝血管瘤需行手术治疗的患者的临床资料,术前均行肝脏三维重建,全方位立体显示肝内瘤体与脉管系统的解剖关系,测算肿瘤体积、全肝体积、预切除肝脏体积和剩余肝脏体积.结果 12例患者均成功完成肝血管瘤包膜外剥脱术.三维可视化系统可立体显示肝内瘤体及肝内脉管结构.术前预切除肝脏体积与术后实际切除肝脏质量分别为（612±182） ml和（80±22） ml,模拟值与实际值比较差异有统计学意义（t=11.34,P＜0.05）.所有患者术后恢复良好,术后无肝功能衰竭发生.结论 三维可视化系统可立体显示肝脏脉管结构,可避免肝内重要脉管结构的损伤,在复杂肝血管瘤切除术中具有一定的临床应用价值.

Objective To evaluate three-dimensional visualization system for precise hepatectomy in patients with complicated hepatic hemangiomas.Methods The clinical data of 12 patients with complicated hepatic hemangiomas who received precise hepatectomy at the Affiliated Chenggong Hospital of Xiamen University from October 2012 to October 2013 were retrospectively analyzed.The preoperative image data of the liver were three-dimensionally reconstructed by the visualization system,it can three-dimensionally reflect the anatomical relationship between the hepatic tumor and vascular structures,calculate the volume of the tumor,total liver volume,volume of liver to be resected,remnant liver volume.The difference between actual liver resection volume and predicted liver resection volume was analyzed by t test.Results 12 cases were successfully treated by hemangiomas extracapsular enucleation.The three-dimensional visualization system can reflect the anatomical relationship between the hepatic tumor and vascular structures.The predicted liver resection volume and the actual liver resection volume were （612 ± 182） ml and （80 ± 22） ml,respectively.The difference of the predicted and the actual values were statistically significant （t =11.34,P 〈 0.05）.All patients recovered well without major complications.Conclusions The three-dimensional visualization system can reflect the vascular structures of the liver,and avoid injury to vascular structures,which has an important clinical value for the complicated hepatic hemangiomas resection.