计算机辅助规划系统在肝门部胆管癌手术规划中的应用价值

Application values of computer-assisted preoperative planning of hilar cholangiocarcinoma

目的探讨计算机辅助手术规划系统在肝门部胆管癌术前手术规划中的应用价值。方法回顾性分析2013年1至12月期间解放军总医院实施的47例联合部分肝脏切除的肝门部胆管癌根治术患者的病例资料，根据其术前是否进行计算机辅助手术规划，将47例患者分为两组，即经计算机辅助手术规划组（CASP）和未经计算机辅助手术规划组（WCASP），统计两组患者的术前相关检查、术前预案、实际手术情况及术后并发症发生情况，并比较两组患者间的差异是否具有统计学意义。结果CASP组的平均手术时间为（6．5±1．3）h，术中平均出血量为（672．0±214．3）ml；WCASP组的平均手术时间为（7．9±2．9）h，术中平均出血量为（870．0±330．1）ml。经统计学分析，两组间平均手术时间的差异有统计学意义（P：0．028）；两组间术中平均出血量的差异亦有统计学意义（P=0．016）。CASP组患者术中的首次送检阴性率高于WCASP组，且两组间的差异有统计学意义（P=0．043）。两组患者术后并发症发生率差异无统计学意义（P=0．419）。结论计算机辅助手术规划系统可辅助设计最优化的手术方案，在肝门部胆管癌的术前手术规划中具有较好的应用价值。

Objective To explore the application value of computer-assisted preoperative planning of hilar cholangiocarcinoma. Methods Retrospective analyses were conducted for the clinical data of 47 patients with hilar cholangiocarcinoma undergoing radical resection plus hemihepatectomy from January to December 2013. According to whether computer-assisted preoperative planning was used, they were divided two groups of computer-assisted surgical planning （CASP） and without computer-assisted surgical planning （WCASP）. Then we analyzed the data including preoperative examinations, preoperative planning, intraoperative findings and postoperative complications. Results There were 31 cases of hilar vascular invasion by tumor. Among 29 cases of CASP, left hepatic artery originated from left gastric artery （ n = 6）, right posterior bile duct drained into left hepatic bile duct （ n = 1 ） and right posterior bile duct run into common hepatic bile duct （ n = 2）. The mean operative duration of CASP was （6. 5± 1.3 ） h and the mean volume of intraoperative bleeding （672. 0 ± 214. 3） ml; while the mean operative duration of WCASP was （7.9 ± 2. 9） h and the mean volume of intraoperative bleeding （870. 0 ± 330. 1 ） ml. By statistical analysis, the inter-group differences of mean operative duration had statistical difference （ P = 0. 028 ） and the inter- group differences of mean volume of intraoperative bleeding had statistical difference （P = O. 016）. The ratio of first negative test in group CASP was higher than that of group WCASP and the inter-group differences had statistical significance （P = 0. 043 ）. But the inter-group rate of postoperative complications had no significant difference （P = 0.419 ）. Conclusions The computer-assisted surgical planning system provides accurate information so that an optimal surgical protocol may be designed by surgeons. And it has great application values in preoperative surgical planning for hilar cholangiocarcinoma and enjoys wide prospects in precise liver surgery.