计算机辅助手术系统在儿童肝脏肿瘤根治术中的应用研究

The Study of the Clinical Application of Computer-assisted Surgery System for Pediatric Liver Tumor

目的研究计算机辅助手术系统(Computer-assisted surgery system,CAS)在儿童肝脏肿瘤根治术中的临床应用价值。方法对2015年10月至2017年3月在复旦大学附属儿科医院行肝脏肿瘤切除术的19例患儿术前利用CAS对CT图像进行三维重建。分析19例患儿的手术时间、术中出血量、术后ICU住院天数、肿瘤累及肝段数、血管变异以及肝脏体积剩余情况。结果 19例患儿手术时间为3.5(3.0,4.0)h,术中出血量为100(35,350)m L,术后ICU住院天数为1(1,2.7)d。在重建的19例患儿中存在门静脉变异,包括3例Ⅰ型,1例Ⅱ型,1例Ⅲ型。计算术后残留肝脏体积得出两段切除术的患儿剩余肝脏体积为68%～80%,左半肝切除术后患儿为57%～68%,右半肝切除术后患儿为53%～63%。结论术前三维模型重建能够为术者提供更加直观的解剖结构信息,提高手术切除的精准性,使得更多复杂肝脏肿瘤患儿获得手术根治切除的机会。

Objective To explore the clinical application of the Computer-assisted surgery system （CAS） on liver tumor resection surgery. Methods The clinical data of 19 liver tumor patients whose CT scan images were transferred to CAS to generate the 3-dimentional （3D） model that provided the anatomy of liver, tumor, hepatic vein, portal vein and the volume of the liver. The involving hepatic segments, surgical time, bleeding volume and the time of ICU-stay of these patients were collected. Results The median time of surgery was 3.5 （3.0, 4.0） h, the amount of surgical bleeding was 100 （35,350） ml and the ICU-stay time was 1 （ 1, 2.7 ） d. There were portal veins variations in those patients ： type [ （ n=3 ）, type Ⅱ（ n = 1 ） and type Ⅲ （ n = 1 ）. The residual liver volume ranged from 53% - 80%. Conclusion The 3D model generated by the CAS contributed to the surgical plan for children with complex hepatic tumors. With the aid of 3D model, the surgeons could have the more detailed information of the anatomy of the tumor, liver and the vessels which im- proves the safety of the tumor resection.