自主设计3D打印截肝导板在肝癌切除手术中的初步应用

Application of independently-designed three-demensional printed navigation templates for hepatectomy in hepatic surgical oncology

目的探索自主设计3D打印截肝导板在肝癌切除手术中的应用价值。方法回顾分析2016年6月至2018年6月湖南省肿瘤医院肝胆肠外科45例肝癌手术患者资料,男性36例,女性9例,年龄40~70岁。依据治疗方式分为观察组(3D打印截肝导板辅助肝癌切除,n=25)和对照组(传统肝切除手术,n=20)。计算观察组虚拟切除肝体积、实际切除肝体积等,Pearson相关分析二者相关性。比较两组手术时间、出血量、术中肝内管系意外损伤、术后住院时间等。结果观察组均成功完成3D建模,肝内、肝外管系重建成功,模拟手术。观察组虚拟切除肝体积与实际切除肝体积比较,差异无统计学意义(P>0.05)。虚拟切除肝体积与实际切除肝体积呈正相关(r=0.991,P<0.05)。观察组出血量低于对照组[(245.1±22.3)ml比(308.6±19.9)ml],且术后住院时间少于对照组[(7.4±0.2)d比(8.6±0.4)d],差异有统计学意义(P<0.05)。观察组无肝内管系意外损伤,对照组肝中静脉意外损伤1例,右肝静脉2级属支意外损伤1例。术后第4天和第7天,观察组AST与对照组比较显著降低,差异有统计学意义(P<0.05)。结论基于磁共振图像的3D重建技术,能够还原肝内管系走行与肿瘤的位置关系。3D打印截肝导板能够有效指导手术入路、规划手术,在保证切缘同时最大限度保护剩余肝组织,减少出血量和意外损伤,实现肝癌的精准切除。

Objective To investigate the clinical value of independently-designed three-demensional printed navigation templates for hepatectomy in hepatic surgical oncology.Methods A retrospective study was conducted on 45 patients(including 36 males and 9 females,aged from 40 to 70 years)with hepatocelluar carcinoma treated by hepatoctomy from Department of Hepatobiliary and Intestinal Surgery of Hunan Cancer Hospital from June 2016 to June 2018.These patients were divided into observation group(patients conducted with the 3D navigation-template-aided operation,n=25)and control group(patients conducted with regular operation,n=20)according to operation approach.Virtual liver resection volume and actual liver resection volume were calculated in the observation group,and the correlationship between the volume of virtual liver resection and actual liver resection was analyzed by Pearson correlation analysis.The operative time,intraoperative blood loss,intraoperative intrahepatic duct injury and postoperative hospital stay were compared between the two groups.Results In the observation group,3D modeling was successfully completed and intrahepatic and extrahepatic duct reconstruction was successful,surgical simulation.There were no statistically significant difference between the virtual and actual resected liver volume in the observation group(P>0.05).The virtual resected liver volume was positively correlated with the actual resected liver volume(r=0.991,P<0.05).Volume of intraoperative blood loss in the observation group was lower than that in the control group[(245.1±22.3)ml vs.(308.6±19.9)ml],and the length of hospital stay was shorter than that in the control group[(7.4±0.2)d vs.(8.6±0.4)d],the difference was statistically significant(P<0.05).There was no accidental injury of intrahepatic duct in the observation group,1 case of accidental injury of middle hepatic vein and 1 case of accidental injury of secondary branch of right hepatic vein in the control group.The AST of the observation group was significantly reduced compared with that of the control group on the 4 th and 7th days after the operation,and the difference was statistically significant(P<0.05).Conclusions 3D reconstruction of liver based on high quality MR images,can facilitate restoring the adjoint relationship between hepatic duct system and liver tumor.3D printed navigation templates effectively guide certain kinds of hepatectomy,ensure that the cutting edge at the same time protect the rest of the liver tissue,reduce bleeding and accidental damage,realize accurate tumor resection.