三维可视化技术联合3D腹腔镜在复杂肝肿瘤切除术中的应用

Application of three-dimensional visualization combined with 3D laparoscopy in hepatectomy for complex liver neoplasm

目的探讨三维可视化技术联合3D腹腔镜在复杂肝肿瘤切除术中的应用价值。方法回顾性分析2018年1月至2019年12月浙江大学医学院附属金华医院肝胆胰外科35例复杂肝肿瘤患者临床病例资料。术前应用三维可视化技术进行肝脏三维重建,明确肝内脉管系统的解剖关系及其与肿瘤的毗邻关系。术中联合3D腹腔镜行复杂肝肿瘤切除术,观察手术方式、手术时间、术中出血量、术后住院时间、术后并发症情况等。结果35例复杂肝脏肿瘤患者均完成3D腹腔镜手术,无中转开腹。手术时间为60~410 min,平均(211±94)min;术中出血量为50~2000 mL,平均(294±152)mL;术后住院时间为4~15 d,平均(7.1±2.2)d。术后发生胆漏1例,经过保守治疗后好转出院。结论三维可视化技术联合3D腹腔镜能精准定位肿瘤位置并提供良好的手术视野,有助于术中出血控制,提高手术安全性。

Objective To explore the application of three-dimensional(3D)visualization combined with 3D laparoscopy in hepatectomy for complex liver neoplasm.Methods The clinical data of 35 patients who underwent hepatectomy between Jan.2018 and Dec.2019 in the Affiliated Jinhua Hospital of Zhejiang University were retrospectively analyzed.3D visualization reconstruction of liver was performed preoperatively to clarify the anatomy relationship of intrahepatic vasculature and its adjacent relationship with tumor.The precise hepatectomy under 3D laparoscopy was performed subsequently.The surgical methods,operation time,intraoperative blood loss,complications incidence and postoperative hospitalization time were observed.Results All 35 patients underwent 3D laparoscopic hepatectomy successfully.No patient was transferred to open surgery.The operation time was 60~410(211±94)min,the intraoperative blood loss was 50~2000(294±152)mL.The postoperative time of hospitalizaition was 4~15(7.1±2.2)d.One patient suffered biliary leakage and was cured by conservative treatment.Conclusion 3D visualization combined with 3D laparoscopy can accurately locate the tumor position and provide good surgical vision,which is helpful for intraoperative bleeding control and improves surgical safety.