三维可视化技术在肝癌合并门静脉或肝静脉癌栓精准手术切除中的应用

Application of 3D visualized technology in the precise resection of hepatic cancer complicated by portal or hepatic vein tumor thrombus

目的研究三维可视化技术在肝癌合并门静脉或肝静脉癌栓的精准手术切除中的应用价值。方法选取2015年2月至2017年5月广东省第二人民医院普外二科收治的11例肝癌合并门静脉或肝静脉癌栓患者,行上腹部256排螺旋CT增强扫描,并收集CT原始数据,使用海信计算机辅助手术系统重建患者腹腔脏器和血管三维模型。根据三维模型和肝脏分段,精确定位肿瘤,判断癌栓侵犯血管的程度。通过系统中的仿真手术功能,计算切除肝脏、残余肝脏体积,明确最佳手术方案。根据最佳手术方案完成手术,并将仿真手术预切除肝脏体积和实际手术切除肝脏体积进行比较。结果重建的三维模型可真实呈现肝脏、肿瘤、血管的解剖结构和位置毗邻关系。据此制定最佳手术方案可高效、精准、安全地实施手术,提高手术切除率。仿真预切除肝脏体积和手术实际切除肝脏体积比较无统计学意义(t=0.85,P>0.05)。结论三维可视化技术有助于指导肝癌合并门静脉或肝静脉癌栓的精准诊疗。

Objective To investigate the applied value of 3 D visualized technology in the precise surgical resection of hepatic cancer complicated by portal or hepatic vein tumor emboli. Methods From February 2015 to May 2017, altogether 11 patients with pathologically diagnosed hepatic cancer complicated by portal or hepatic vein tumor thrombus were enrolled into the study. Upper abdominal contrast-enhanced CT was performed with a 256-slice spiral CT scanner. Original data was collected and 3 D model of abdominal organs and blood vessel was reconstructed by using Hisense Computer Aided Surgery system. According to 3 D model and Couinaud 's liver segmentation, the tumor was accurately located to evaluate the vascular invasion status of tumor thrombus. We then calculated the volume of both the resected and residual liver using the simulated surgery function of this system, and determined the best resection scheme. Surgery was then performed according to the determined plan and the resected liver volume between simulated and actual surgery was compared. Results The reconstructed 3 D model revealed the authentic anatomical structure of the liver, tumor and blood vessels as well as the adjacent relationship among them. The best surgical scheme developed hereby facilitated to perform the surgery effectively, precisely and safely with improved resection rate. There was no statistical difference between the resected liver volume in simulated surgery and that in actual surgery(t=0.85, P>0.05). Conclusion 3 D visualized technology can contribute to precise diagnosis and treatment of hepatic cancer complicated by portal or hepatic vein tumor thrombus.