三维手术模拟系统在肝癌患者极量肝切除术中的应用：35例报告

Application of a three-dimensional surgery simulation system in patients with liver cancer who underwent extended liver resections： experience in 35 patients

目的 探讨三维手术模拟系统在极量肝切除中的应用价值.方法 采用三维手术模拟系统行手术前评估,运用计算机模拟切除的肝脏体积、剩余肝脏体积和手术切缘,将其与手术后实际切除肝脏体积和实际手术切缘进行对比,最后采取软件虚拟肝切除功能将手术方案进行优化.结果 在三维手术模拟系统的指导下,35例肝癌患者顺利完成极量肝切除,术后第2天超声显示发生腹水和中等量胸水各1例,出现肝衰1例,无胆漏及围手术期死亡发生.所有并发症经积极处理均好转.术后平均住院22 d（范围6～85 d）.术后观察1个月无一复发.结论 三维手术模拟系统可有效、准确评估和模拟肝脏手术情况,对极量肝切除手术的开展具有较好的指导及帮助作用.

Objective To explore the application of a three-dimensional simulation system in extended liver resections.Methods A three-dimensional surgical simulation system was used for preoperative assessment and for computer simulation to estimate the resected liver volume,the residual liver volume,and the surgical resection margins.The software virtual liver resection was used to choose the most optimal surgical option.The actual resection,the postoperative liver volume and the actual surgical resection margins were compared.Results 1 patient was diagnosed by ultrasound to develop ascites on post-operative day 2.Another patient was diagnosed by transthoracic ultrasound to have moderate pleural effusion on postoperative day 1.Postoperative liver failure developed in 1 patient.There was no patient who developed bile leakage.The average length of stay was 6 ～ 85 days （average 22 d）.There was no recurrence within 1 month after surgery and there was no postoperative deaths.Condusions The three-dimensional surgery simulation system was effective.It gave an accurate evaluation and simulation of the liver surgery.In extended liver resection,it gave good guidance and help.