术前肝脏三维重建应用于原发性肝癌精准切除手术的研究

Preoperative Three-Dimensional Reconstruction of the Liver Applied to Precision Resection of Primary Hepatocellular Carcinoma

目的:探究术前肝脏三维重建应用于原发性肝癌精准切除手术的效果。方法:选取2019年1月至2022年1月我院收治的107例原发性肝癌患者,使用Excel生成107个随机数字,每个数字对应一位患者,按照生成的随机数从小到大的顺序,将前53个数字分配给对照组,剩下的54个数字分配给研究组:对照组(n=53)根据常规肝脏二维影像学检查结果进行传统术前评估,研究组(n=54)应用肝脏三维重建技术进行术前评估,比较两组患者的临床指标、肝脏切除体积、肝功能各项指标及血清糖类抗原19-9(CA19-9)、胰岛素样生长因子1(IGF-1)、癌胚抗原(CEA)和甲胎蛋白(AFP)水平,记录患者术后并发症情况。对患者进行1年随访,记录其复发转移、死亡情况。结果:两组间手术时间、输血率比较差异无统计学意义(P>0.05);与对照组相比,研究组患者术中出血量减少,住院时间及肛门排气时间缩短(P<0.05)。两组实际切除肝脏体积比较差异无统计学意义(P>0.05),研究组的术前测算值低于对照组,实际切除肝体积比高于对照组(P<0.05)。术前两组患者的各项肝功能指标比较差异无统计学意义(P>0.05);两组患者术后肝功能指标与术前比较差异有统计学意义,AST、ALT、TBIL、AFP水平降低,ALB水平升高,且研究组的患者在升高和降低方面比对照组的患者幅度更大(P<0.05)。术前两组患者的血清lGF-1、CEA、CA19-9、AFP水平比较差异无统计学意义(P>0.05);治疗后患者的血清lGF-1、CEA、CA19-9、AFP水平均降低,且研究组患者在升高和降低方面比对照组的患者幅度更大(P<0.05)。对照组术后发生1例胆漏,4例伤口感染,3例肺部感染,3例腹腔积液,总并发率为20.75%(11例/53例),复发转移8例(15.09%);研究组术后发生2例肺部感染,1例伤口感染,1例腹腔积液,总并发率为7.41%(4例/54例),复发转移2例(3.70%)。研究组患者术后并发症发生率(7.41%)及复发转移率(3.70%)低于对照组(20.75%,15.09%),差异有统计学意义(P<0.05)。结论:术前肝脏三维重建技术能够提高原发性肝癌切除手术的精准性和安全性,降低手术后患者发生并发症的几率,降低对其肝功能的损伤,具有广阔的应用前景,临床应用价值较高。

Objective:To investigate the impact of preoperative liver reconstruction in accurate resection for primary liver cancer.Methods:From January 2019 to January 2022,a total of 107 patients were admitted to our hospital.Patients were grouped by computer random numbers:Excel was used to generate 107 random numbers,each corresponding to a patient,and the first 53 numbers were assigned to the control group,and the remaining 54 numbers to the research group according to the order of the generated random numbers from smallest to largest.In the control group(n=53),conventional preoperative evaluation was performed based on conventional two-dimensional imaging of the liver,and in the study group(n=54),preoperative evalua-tion was performed by applying three-dimensional reconstruction of the liver,and the clinical indexes,hepatic resection volume,liver function indexes,and the levels of serum glycoantigen 19-9(CA19-9),insulin-like growth factor 1(IGF-1),carcinoembryonic antigen(CEA),and alpha-fetoprotein(AFP)of the patients in the two groups were compared.and alpha-fetoprotein(AFP)levels,and postoperative complications were recorded.The patients were followed up for 1 year and their recurrence metastasis and death were recorded.Results:There was no significant difference in operation time and blood transfusion rate between the two groups(P>0.05).Compared with the control group,the amount of blood loss during operation in the study group was reduced,and the length of hospital stay and anal exhaust time were shortened(P<0.05).There was no significant difference in the actual resected liver volume between the two groups(P>0.05).The pre-operative measurement value of the study group was lower than that of the control group,and the actual resec-ted liver volume ratio was higher than that of the control group(P<0.05).There was no significant difference in liver function indexes between the two groups before surgery(P>0.05).There were statistically significant differences in postoperative liver function indexes between the two groups,with AST,ALT,TBIL and AFP levels decreased and ALB levels increased,and the increase and decrease of patients in the study group was greater than that in the control group(P<0.05).There was no significant difference in serum levels of lGF-1,CEA,CA19-9 and AFP between 2 groups before surgery(P>0.05).After treatment,the serum levels of lGF-1,CEA,CA19-9 and AFP were all decreased,and the increase and decrease of patients in the study group were greater than those in the control group(P<0.05).In the control group,there were 1 case of bili-ary leakage,4 cases of wound infection,3 cases of pulmonary infection,and 3 cases of abdominal effusion.The total complication rate was 20.75%(11 cases/53 cases),and there were 8 cases of recurrence and me-tastasis(15.09%).In the study group,there were 2 cases of pulmonary infection,1 case of wound infection and 1 case of abdominal effusion,the total complication rate was 7.41%(4 cases/54 cases),and there were 2 cases of recurrence and metastasis(3.70%).The incidence of postoperative complications(7.41%)and recurrence and metastasis(3.70%)in the study group were lower than those in the control group(20.75%,15.09%),and the differences were statistically significant(P<0.05).Conclusion:Three-dimensional pre-operative liver reconstruction technology can improve the accuracy and safety of primary liver cancer resection,reduce the risk of complications after surgery,reduce the damage to their liver function,and has a broad ap-plication prospect and high clinical application value.