CT和3D重建在肝泡型包虫病离体肝切除和自体肝移植术前评价重要血管中的作用

Value of preoperative computed tomography and three-dimensional reconstruction of major vascularstructures before ex vivo liver resection and autotransplantation for hepatic alveolar echinococcosis[Abstract!Objective

目的评价电子成像(CT)和三维重建(3DR)技术在肝泡型包虫病(AE)行离体肝切除联合自体肝移植(ELRA)术前诊断重要血管被病灶侵犯的程度、形态和功能中的作用以及对血管手术的指导价值。方法回顾性收集2017年1月至2019年1月在我中心因终末期肝AE接受ELRA手术,并且术前影像、术中摄影、术后病理等资料完整的患者资料40例,术前行CT和3DR诊断肝静脉血流出道系统(HVs)、下腔静脉(IVC)、肝门静脉供血系统(PVs)以及肝动脉供血系统(HAs)被病灶侵犯的严重程度,结合血管造影、术中诊断、摄影资料、血管病理结果评估其形态和功能,提出对病变血管的切除/重建的指导意义。结果CT与3DR对于血管被病灶侵犯程度、形态功能和处理方式的准确判断率分别是68.1%、71.9%、78.9%和57.5%、89.2%、71.1%,每个对应数据之间差异有统计学意义(P值均<0.05)。CT与3DR对于术中是否使用人造血管的准确预测率分别是77.5%和70.0%(P<0.05)。结论肝AE患者ELRA术前在评价重要血管被病灶侵犯的严重程度和指导血管手术方面推荐使用CT方法进行评估,而在评估其形态和功能方面推荐借助专业的3DR技术;在预测术中人造血管使用方面CT更具指导意义,但仍需寻找更有效的措施。

Objective To evaluate the application value of preoperative computed tomography (CT) and three-dimensional reconstruction (3DR) of major vessels regarding lesion infiltration severity, vascular morphology & function and predict vascular surgeries during ex vivo liver resection and autotransplantation (ELRA) for end-stage hepatic alveolar echinococcosis (AE). Methods Preoperative radiological & angiographical, intraoperative photographic and pathological materials were retrospectively collected in 40 consecutive patients undergoing ELRA for end-stage hepatic alveolar echinococcosis from January 2017 to January 2019. Severity of lesion infiltration, morphological & functional status as well as predictive value for surgical planning of hepatic venous system ( HVs), inferior vena cava (IVC), portal venous system (PVs) and hepatic arterial supply system (HAs) were estimated? then compared with those built golden standards: angiography, intraoperative diagnosis and pathological examinationss. Results Evaluation accuracy of CT and 3DR for lesion infiltration severity, vascular morphology & function and predicting vascular surgeries respectively were 68. 1 %, 71. 9%, 78. 9% and 57. 5%, 89. 2%, 71. 1% and all paired data had statistical significance (all P<0. 05). Furthermore, CT had a higher certainty of predicting the use of vascular prosthesis during surgery than 3DR (77. 5% and 70. 0%, P<0. 05). Conclusions Pre-ELRA CT is recommended for evaluating lesion infiltration severity and predicting corresponding vascular surgery. However, 3DR has more certainty in evaluating vascular morphology & function. Furthermore, CT is more reliable than 3DR in predicting vascular prosthesis during ELRA. However, optional better solutions should be studied for higher assurance.