uNavigator双导航系统在困难部位腹腔镜肝切除术的初步应用

Preliminary application of uNavigator dual navigation system during laparoscopic liver resection at difficult sites

目的探讨uNavigator双导航系统在腹腔镜肝切除术围手术期的应用价值。方法对1例53岁女性病人采用uNavigator双导航系统行腹腔镜肝切除术。该例病人因“体检发现肝脏占位2 d”就诊,有腰椎间盘突出症病史,术前血常规、凝血功能、肝功能和肾功能均正常,通过术前腹部增强CT诊断为11.2 cm的肝海绵状血管瘤,位于肝右叶,靠近右后、右前肝蒂及肝右静脉。根据腹部增强CT的DICOM数据重建病人肝脏的增强现实全息影像,用于医患沟通、术前手术规划和术中导航。于2024年1月25日行uNavigator双导航系统引导下腹腔镜肝右后叶及右前叶背侧段切除术。术后病理证实为肝海绵状血管瘤。结果利用三维图像与实际肝脏的融合图像标记血管瘤的左侧边界、右前和右后肝蒂的走行。使用超声刀沿边界离断肝实质,采用Endo-GIA切断右后肝蒂及肝右静脉主干。手术时间为180 min,出血量约300 mL。术后病人恢复良好,术后第8天出院。结论uNavigator双导航系统可促进医患沟通,帮助医生术前规划和术中导航。

Objective To explore the application of uNavigator dual navigation system during perioperative period of laparoscopic liver resection.Methods This 53-year-old female had a history of lumbar disc herniation.Preoperative complete blood count,coagulation function,liver function and renal function were all normal.An 11.2 cm hepatic hemangioma was detected in right lobe of liver close to right posterior and right anterior hepatic pedicles and right hepatic vein.Laparoscopic resection of right posterior lobe and dorsal segment of right anterior lobe was planned.Three-dimensional(3D)hepatic image was reconstructed based upon the DICOM data of abdominal contrast-enhanced computed tomography(CT)for physician-patient communication,preoperative surgical planning and intraoperative navigation.Results Fusion of three-dimensional image and actual liver was utilized for marking left border of hemangioma and course of right anterior and right posterior hepatic pedicles.An ultrasonic scalpel was applied for separating liver parenchyma along border and Endo-GIA for resecting right posterior hepatic pedicle and main right hepatic vein.Operative duration was 180 min and volume of blood loss approximately 300 mL.She recovered well post-operation and was smoothly discharged from hospital at Day 8.Conclusion uNavigator dual navigation system may promote doctor-patient communication and aid clinicians in preoperative planning and intraoperative navigation.