三维可视化技术在儿童活体肝移植中的应用

Application of three-dimensional visualization technique in pediatric living donor liver transplantation

目的 探讨三维可视化技术在儿童活体肝移植供者术前评估中的应用价值.方法 回顾性分析2013年1月至2015年12月上海交通大学医学院附属仁济医院肝脏外科所实施的348例儿童活体肝移植供者评估资料.每对供受者均为亲属关系.对比分析三维影像重建血管分型、供肝体积及术中实测体积和解剖特点.应用配对t检验比较模拟切取供肝体积与实测供肝体积之间差异.结果 男性受者168例,女性受者180例,年龄5～176个月,中位年龄8个月,平均体重（9.4±5.4）kg,平均腹围（56.3±13.3） cm;男性供者131例,女性供者217例,年龄19 ～ 59岁,平均年龄（32.0±13.0）岁.348例供肝中,左外叶308例（88.5％）,其中减体积5例（1.4％）、超减体积2例（0.6％）;左半肝32例（9.2％）;右半肝7例（2.0％）;右后叶1例（0.3％）.平均三维模拟供肝体积和实测供肝体积的差异无统计学意义[（300.3±80.7）ml比（287.6±71.5）ml] （P =0.15）,平均移植物质量为（291.9±75.6）g,平均移植物体重比为（3.2±1.0）％.供者平均手术时间为（205±59） min,平均术中出血量为（153±49） ml,平均术后住院时间为（7±3）d.结论三维可视化重建技术能够准确评估儿童活体肝移植供者肝脏解剖情况,保障供受者医疗安全.

Objective To investigate the value of three-dimensional（3D） visualization technology for donor evaluation in pediatric living donor liver transplantation（LDLT）.Methods The clinical data of 348 familial donors who underwent LDLT from January 2013 to December 2015 in Renji Hospital,Shanghai Jiaotong University School of Medicine were reviewed retrospectively.3D visualize-vascular type and liver grafts volume were analyzed and compared to the actual volume and anatomy.Paired t-test was used to compared the liver volume between 3D visualization estimated-liver grafts and actual volume.Results Among the LDLT recipients,168 were male and 180 were female aged from 5 to 176 months（median age 8 months）,and average body weight was （9.4 ± 5.4） kg,average abdominal circumference was （56.3 ± 13.3）cm.Among the LDLT candidates,131 were male and 217 were female aged from 19 to 59 years （average age （32.0 ± 13.0）years,median age 30 years）.The type of liver grafts from 348 donors included：308 left lateral lobe （88.5%） （5 were reduced-size grafts （1.4%） and 2 were hyper reduced-size grafts （0.6%））,32 left lobe donor（9.2%）,7 right lobe donor（2.0%） and 1 right posterior lobe donor（0.3%）.The difference between the mean volume of 3D visualization estimated-liver grafts and the mean actual volume was not significant （（300.3 ± 80.7） ml vs.（287.6 ± 71.5） ml） （P =0.15）,the average weight was （291.9 ±75.6）g and mean graft recipient body weight ratio was （3.2 ±0.1）%.The mean operation time was （205 ± 59）minutes,the mean blood loss was （153 ± 49）ml,and the mean postoperative hospital stay was （7 ± 3）days.Conclusion 3D visualization reconstruction technique can accurately assess the donor condition and ensure the safety both donors and recipients.