3D打印技术辅助腹腔镜解剖性肝Ⅷ段切除术的应用价值

Application value of three-dimensional printing technology assisted laparoscopic anatomic liver resection of segment 8

目的探讨3D打印技术辅助腹腔镜解剖性肝Ⅷ段切除术(Lap-S8)的应用价值。方法采用回顾性描述性研究方法。收集2019年1月至2020年12月湖南省人民医院收治的8例肝癌(7例肝细胞癌、1例肝内胆管细胞癌)行3D打印技术辅助Lap-S8病人的临床病理资料;男7例,女1例;中位年龄为56.5岁,年龄范围为49.0~80.0岁。8例肝癌病人中,6例行腹腔镜解剖性肝Ⅷ段全切除术,1例行腹腔镜解剖性肝Ⅷ段腹侧亚段切除术,1例行腹腔镜解剖性肝Ⅷ段背侧亚段切除术。8例病人均采用3D打印技术辅助术前评估和术中导航。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊、互联网和电话方式进行随访,了解病人术后生存及肿瘤复发情况。随访时间截至2021年3月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)手术情况:8例病人均顺利完成3D打印技术辅助Lap-S8,无中转开腹。8例病人手术时间为(216±41)min,肝门阻断时间为(56±11)min,术中出血量为75 mL(50~300 mL)。8例病人无术中输血,手术切缘均为阴性。(2)术后情况:8例病人术后住院时间为(9±3)d。8例病人均未发生术后出血、胆瘘、肝脓肿和腹腔感染等并发症。(3)随访情况:8例病人均获得随访,随访时间为3.0~24.0个月,中位随访时间为12.5个月。随访期间,8例病人中,1例术前诊断为复发性肝细胞癌病人于术后5个月发生肿瘤复发,病人再次行腹腔镜手术,并采用经导管动脉化疗栓塞术和靶向治疗后带瘤生存;其余7例病人无肿瘤复发。结论3D打印技术辅助Lap-S8安全、可行。

Objective To investigate the application value of three-dimensional(3D)printing technology assisted laparoscopic anatomic liver resection of segment 8(Lap-S8).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 8 liver cancer patients including 7 cases with hepatocellular carcinoma and 1 case with intrahepatic cholangio-carcinoma who underwent 3D printing technology assisted Lap-S8 in the Hunan Provincial People′s Hospital from January 2019 to December 2020 were collected.There were 7 males and 1 female,aged from 49.0 to 80.0 years,with a median age of 56.5 years.Of the 8 patients,6 cases underwent laparoscopic anatomic liver resection of the entire segment 8,1 case underwent laparoscopic anatomic liver resection of ventral subsegmental of the segment 8 and 1 case underwent laparoscopic anatomic liver resection of dorsal subsegmental of the segment 8.3D printing technology was used to assist preoperative evaluation and intraoperative navigation for all 8 patients.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow-up.Follow-up was conducted using outpatient examination,internet or telephone interview to detect survival and tumor recurrence of patients after operation up to March 2021.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results(1)Surgical situations:all the 8 patients underwent 3D printing technology assisted Lap-S8 successfully,without conversion to open surgery.The operation time,hepatic portal occlusion time and volume of intraoperative blood loss of the 8 patients were(216±41)minutes,(56±11)minutes and 75 mL(range,50 to 300 mL),respectively.There was no intraoperative blood transfusion in 8 patients,and the surgical margin of the 8 patients was negative.(2)Postoperative situations:the duration of postoperative hospital stay of the 8 patients were(9±3)days.There was no complication such as postoperative hemorrhage,biliary fistula,liver abscess or abdominal infection occurred.(3)Follow-up:all the 8 patients were followed up for 3.0‒24.0 months,with a median follow-up time of 12.5 months.During the follow-up,1 of 8 patients with preoperative diagnosis of recurrent hepatocellular carcinoma developed tumor recurrence at 5 months after operation.The patient underwent laparoscopic surgery followed with the transcatheter arterial chemoembolization and target therapy,and survived with tumor.There was no tumor recurrence in the other 7 patients.Conclusion 3D printing technology assisted Lap-S8 is safe and feasible.