计算机辅助手术系统在小儿巨大肝间叶性错构瘤诊治中的应用

Usefulness of computer assisted surgical system for hepatic mesenchymal hamartoma in children

目的探讨计算机辅助手术系统(海信CAS)在小儿巨大肝间叶性错构瘤(HMH)诊治中的临床价值。方法自2010年9月至2015年10月,我们收治5例HMH患儿,术前均行上腹部增强CT检查,3例(2013年7月至2015年10月)应用海信CAS对患儿CT资料行三维重建及模拟肝切除,制定手术计划,术中实施精准肝切除术。结果 2例(2010年9月至2013年5月)根据术前CT检查分别实施肝右叶切除术及肝左叶切除术。3例(2013年7月至2015年10月)应用海信CAS系统成功进行肝脏及肿瘤的三维重建,并进行模拟肝切除,根据术前制定的手术计划分别成功实施:肝Ⅱ、Ⅲ、Ⅴ、Ⅷ部分及Ⅳ全部切除术,肝Ⅴ段切除术,右半肝切除术。术后恢复好,病理检查证实为HMH。随访3个月至5年未见并发症及复发。结论 HMH影像学检查与肝囊肿相似,易误诊。海信CAS能清晰、直观显示HMH的位置、形态及其与肝内管道系统的关系,其术前规划功能利于术者制定最佳手术方案,实施个体化精准肝脏肿瘤切除。

Objetive To evaluate the usefulness of computer assisted surgical system （Hisense CAS）in assisting the diagnosis and treatment of hepatic mesenchymal hamartoma （HMH ） in chil-dren. Methods From September 2010 to January 2016,5 HMH children undergoing hepatectomy were ana-lyzed.They received preoperative thin-layer computed tomography （CT）.And three-dimensional reconstruction and virtual hepatectomy in Hisense CAS were performed for 3 cases for assisting optimal operative planning and completing anatomic hepatectomy from July 2013 to January 2016. Results All operations were completed successfully and HMH was confirmed by pathology.There was neither complication nor recurrence during a fol-low-up period of 3 months to 5 years.Right and left hepatic lobe resections were achieved for 2 cases.And three-dimensional reconstruction and virtual hepatectomy were completed successfully for another 3 patients. Also 4-segment hepatectomy,V sectionectomy and right hepatectomy were completed after operative planning u-sing CAS. Conclusions It is difficult to diagnose HMH preoperatively.And Hisense CAS can clearly deline-ate the adjacent relationship of tumor and intrahepatic vessels so as to provide optimal operative planning and improve the success rates of complex hepatectomy.