三维可视化技术在腹腔镜肝巨大肿瘤术前评估中的应用价值

Application value of three-dimensional visualization in evaluation of giant liver tumors before laparoscopic resection

目的探讨三维可视化技术在腹腔镜肝巨大肿瘤术前评估中的应用价值。方法回顾性分析2017年1月至2020年12月解放军联勤保障部队第900医院行腹腔镜肝巨大肿瘤切除术的24例患者临床资料。其中男10例,女14例;平均年龄(48±5)岁。原发性肝癌10例,肝血管瘤12例,肝局灶性结节性增生2例。患者均签署知情同意书,符合医学伦理学规定。术前患者获取二维CT图像,导入三维可视化软件中,分别对肝脏、肝动脉系统、门静脉系统、肝静脉系统及肿瘤行图像分割和三维重建。根据三维重建结果进行手术规划,设定肝脏预切除平面,选择合理的手术路径及方式。结果24例患者均顺利完成三维可视化模型重建,三维重建可清楚显示肝内各血管系统解剖、肿瘤具体位置、大小及其与血管的毗邻关系。三维可视化测算全肝体积为2732(2325~2964)ml,肝肿瘤体积1366(1145~1758)ml,预切除肝体积1595(1108~1806)ml,评估剩余肝体积与标准肝体积比值46.7%(41.4%~62.2%)。24例患者均成功完成腹腔镜肝巨大肿瘤切除术。实际手术路径及方式与术前手术规划符合率100%。肝恶性肿瘤和局灶性结节性增生患者实际切除肝体积1602(1203~1806)ml,与术前评估预切除肝体积符合率100%。术中出血量700(100~2000)ml,术后并发症发生率25%(6/24),术后无严重肝功能不全及死亡。结论三维可视化技术可对肝巨大肿瘤切除进行术前精准评估,帮助术中精确操作,提高腹腔镜肝巨大肿瘤切除手术规划的准确性和安全性。

Objective To evaluate the application value of three-dimensional visualization in the evaluation of giant liver tumors before laparoscopic resection.Methods Clinical data of 24 patients who underwent laparoscopic resection of giant liver tumors in the 900;hospital of PLA Joint Logistics Support Force from January 2017 to December 2020 were retrospectively analyzed.Among them,10 patients were male and 14 female,aged (48±5) years on average.10 patients were diagnosed with primary liver cancer,12 cases with hepatic hemangioma and 2 cases with focal nodular hyperplasia of the liver.The informed consents of all patients were obtained and the local ethical committee approval was received.Preoperatively,two-dimensional CT images were collected and imported into three-dimensional visualization software.The images of liver,hepatic artery system,portal vein system,hepatic vein system and tumors were subjected to image segmentation and three-dimensional reconstruction.Surgical plan was determined according to three-dimensional reconstruction results.The resection plane of the liver was pre-designed.Appropriate surgical routes and patterns were selected.Results All 24 patients successfully completed three-dimensional visualization model reconstruction.Three-dimensional reconstruction could clearly display the anatomy of various vascular systems in the liver,the exact location and size of the tumor and its adjacent relationship with blood vessels.Three-dimensional visualization detected that the total liver volume was 2 732(2 325-2 964) ml,the liver tumor volume was 1 366(1 145-1 758) ml,and the pre-resected liver volume was 1 595(1 108-1 806) ml.The estimated ratio of the remaining liver volume to standard liver volume was 46.7%(41.4%-62.2%).All 24 patients successfully completed laparoscopic resection of giant liver tumors.The consistence rate between the actual surgical routes and procedures,and preoperative plans was 100%.The actual resected liver volume of patients with malignant liver tumors and focal nodular hyperplasia was 1 602(1 203-1 806) ml,which was 100% consistent with the pre-resected liver volume before operation.The intraoperative blood loss was 700(100-2 000) ml.The incidence of postoperative complications was 25%(6/24).No severe hepatic insufficiency or death occurred after operation.Conclusions Three-dimensional visualization can deliver accurate evaluation of giant liver tumors before laparoscopic resection,facilitate precise intraoperative procedures,and enhance the accuracy and safety of laparoscopic resection of giant liver tumors.