三维手术模拟系统在复杂性肝脏肿瘤精准肝切除中的应用

Application of 3D surgery simulation system in precise hepatectomy for patients with complicated liver tumor

目的总结肝脏三维手术模拟系统在复杂性肝脏肿瘤精准肝切除中的应用价值。方法回顾分析2009年5月-2014年6月云南省第一人民医院肝胆外科收治的85例复杂性肝脏肿瘤患者的临床资料。前瞻性研究对所有患者术前行肝脏CTA检查,应用三维手术模拟系统进行术前评估,分别计算模拟切除的肝脏体积、剩余肝脏体积和手术切缘,并与术后实际切除肝脏体积和实际手术切缘进行比较,最后通过软件虚拟肝切除功能优化手术方案。结果三维手术模拟系统可以清晰地显示和三维重建正常肝脏组织、肿瘤组织和肝内血管。患者模拟切除肝脏体积与实际切除肝脏体积统计学上具有相关性(P<0.01)。两者均值的差异无统计学意义(P=0.068)。模拟手术切缘与实际手术切缘统计学上也具有相关性(P<0.01),两者均值的差异也无统计学意义(P=0.256)。结论三维手术模拟系统可准确评估和模拟肝脏手术情况,为精准肝切除复杂性肝脏肿瘤提供手术数据和依据。

Objective To investigate the clinical value of three-dimensional surgery simulation system in precise hepatectomy for patients with complex liver tumor. Methods 85 patients underwent complex liver tumor resection in our hospital from May 2009 to June 2014 were retrospectively analyzed. All patients received preoperative liver CTA and then three-dimensional simulation for resected liver volume,the remnant one and surgical margin. By comparing with the actual operation data,the optimized virtual procedure for liver resection was investigated. Results The three-dimensional surgery simulation system can accurately reconstruct and display the demarcation of the tumor and its relationship with adjacent vessels. Virtual resected liver volume was statistically correlated with the actual one（P〈0.01） and the average resected volume has no difference（P=0.068）. Besides,the simulated surgical margin related to the actual margin（P〈0.01） with equal means（P=0.256）. Conclusions The three-dimensional surgery simulation system can precisely evaluate and simulate the procedure of liver surgery preoperatively,providing operation data and guidance for precise complicated tumor resection.