三维可视化技术在复杂型原发性肝癌术前规划中的应用

Application of three dimensional visualization technique in preoperative planning of complex primary liver cancer

目的 探讨三维可视化技术在复杂型原发性肝癌（肝癌）术前规划中的应用价值.方法 本前瞻性研究对象为2014 年2 月至2015 年5 月在安徽医科大学第一附属医院和安徽医科大学第二附属医院收治的22 例复杂型肝癌患者.其中男16 例,女6 例;年龄24～84 岁,中位年龄55 岁.所有患者均签署知情同意书,符合医学伦理学规定.所有患者术前均行增强CT 检查,采集薄层CT 图像数据,利用腹部医学图像三维可视化系统（MI3DVS）进行三维重建,术前评估肿瘤可切除性并进行仿真手术,分别计算全肝体积、肿瘤体积、预切除肝脏体积和残肝体积,标本切除后称重并与预切除肝脏体积进行比较,并观察患者术后并发症发生情况.预切除肝脏体积与实际切除肝脏体积的比较采用t 检验,两者间的相关性采用Pearson 相关分析.结果 本组患者均成功进行了三维重建,可清晰地显示正常肝脏组织、肿瘤组织、肝动脉、门静脉、肝内胆管和肝静脉,对肿瘤与周围组织的毗邻关系显示直观、真实.本组22 例患者中,经过术前评估8 例不适合手术治疗,14 例行开腹肝切除术.术后病理学检查结果显示肝细胞癌10 例,胆管细胞癌4 例.无围手术期死亡.1 例患者术后3 d 出现中等量胸腔积液,1 例术后7 d 出现切口脂肪液化,予对症治疗后好转.患者术后无发生肝衰竭、出血、胆漏等严重并发症.本组手术患者术前预切除肝脏体积为（552±266）ml,手术实际切除肝脏体积为（546±239）ml,差异无统计学意义（t=0.430,P〉0.05）,Pearson 相关分析显示两者间具有相关性（r=0.982,P〈0.05）.结论 三维可视化技术能清晰地显示肝脏肿瘤与肝脏管道的结构关系,并准确预测肝脏肿瘤的切除范围,使患者避免不必要的开腹探查,提高手术切除率,在复杂型肝癌肝切除的术前规划中有一定的指导作用.

Objective To evaluate the application value of three dimensional visualization technique in the preoperative planning of complex primary liver cancer (liver cancer). Methods Twenty-two patients with liver cancer admitted to the First and Second Afifliated Hospitals of Anhui Medical University between February 2014 and May 2015 were recruited in this prospective study. Sixteen patients were males and 6 females, aged between 24 and 84 years with a median age of 55 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients received contrast-enhanced computed tomography (CT) scan before surgery. Imaging data of thin-layer CT scan were collected.Three dimensional reconstruction was conducted by abdominal medicine image three-dimensional visualization system (MI3DVS). The tumor resectability was assessed and simulated surgery was performed before surgery. Total liver volume, tumor volume, target volume of resected liver and residual liver volume were measured. The resected specimen was weighed and compared with the target volume of resected liver. The incidence of postoperative complications was observed. The target and actual volumes of resected liver were compared using t test and the relationship between these two indexes was analyzed using Pearson's correlation analysis. Results Three dimensional reconstruction was successfully performed in all patients. Normal liver tissue, tumor tissue, hepatic artery, portal vein, intrahepatic bile duct and hepatic vein were clearly observed. The adjacent relationship between the tumor and surrounding tissues was directly and accurately visualized. Among 22 patients, 8 cases were ineligible for surgical treatment by preoperative evaluation and 14 underwent open hepatectomy. Postoperative pathological examination revealed that 10 patients were diagnosed with hepatocellular carcinoma and 4 with cholangiocarcinoma. No patients died during perioperative period. One patient was observed with a moderate quantity of hydrothorax at postoperative 3 d and 1 had incisional fat liquefaction at postoperative 7 d, and both were improved after symptomatic therapy. No severe complications, such as liver failure, hemorrhage or biliary leakage occured postoperatively. The target volume of resected liver was (552±266) ml and the actual volume of resected liver was (546±239) ml, and no signiifcant difference was observed (t=0.430, P>0.05). Pearson's correlation analysis revealed the target and actual volumes of resected liver were correlated (r=0.982, P<0.05). Conclusions Three dimensional visualization technique is capable of clearly relfecting the anatomical relationship between liver tumor and hepatic ducts, accurately predicting the resection range of liver tumor, avoiding unnecessary open surgical exploration and enhancing the resection rate. It provides certain guidance for preoperative planning of hepatectomy in patients with complex liver cancer.