3D 技术在中央型肝肿瘤术前规划中的临床应用
| 作者: |
1袁荣发,
1闵家祺,
1邬林泉,
1雷钧,
1朱宝林,
1王恺,
1邵江华
1 南昌大学第二附属医院 肝胆胰外科，江西 南昌 330006 |
| 通讯: |
邬林泉
Email: wulqnc@163.com |
| DOI: | 10.3978/.2018.07.004 |
| 基金: | 国家自然科学基金资助项目（81560396）；江西省自然科学基金资助项目（20171BAB205060）；江西省教育厅科学技术基金资助项目 （GJJ150142）。 |
摘要
目的：探讨 3D 可视化技术在中央型肝肿瘤患者术前规划中的应用价值。
方法：回顾性分析 2016 年 1 月—2017 年 11 月 28 例采用 3D 可视化技术行术前评估的中央型肝肿瘤患者临床资料。术前患者获取二维 CT 图像，导入 3D 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 3D 重建，随后进行肝脏分段及中央型肝肿瘤分型、个体化体积计算；依据 3D 重建结果进行手术规划，选择合理的手术路径及方式。
结果：28 例患者均完成 3D 可视化模型的建立，3D 技术可显示肝内各血管系统解剖、肿瘤具体部位、大小及毗邻关系，进行肝脏个体化分段及肝中叶肿瘤分型。患者全肝体积中位数为 1 532（1 025~ 1 864）mL，肝肿瘤体积 466（45~558）mL，拟切除肝体积为 595（108~806）mL。28 例患者均行肿瘤根治性切除术，实际手术路径及方式与术前手术规划符合率 100%。术中出血量和输血量中位数分别为 700（100~2 000）mL 和 600（0~1 400）mL，输血率为 71.42%（20/28），并发症发生率为28.57%（8/28），术后无严重肝功能不全病例，住院病死率为 0。
结论：3D 可视化技术可以计算剩余肝脏体积，并可提高中央型肝肿瘤肝切除手术前规划的准确率及帮助术中精确操作。
关键词：
肝肿瘤；肝切除术；成像，三维
方法：回顾性分析 2016 年 1 月—2017 年 11 月 28 例采用 3D 可视化技术行术前评估的中央型肝肿瘤患者临床资料。术前患者获取二维 CT 图像，导入 3D 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 3D 重建，随后进行肝脏分段及中央型肝肿瘤分型、个体化体积计算；依据 3D 重建结果进行手术规划，选择合理的手术路径及方式。
结果：28 例患者均完成 3D 可视化模型的建立，3D 技术可显示肝内各血管系统解剖、肿瘤具体部位、大小及毗邻关系，进行肝脏个体化分段及肝中叶肿瘤分型。患者全肝体积中位数为 1 532（1 025~ 1 864）mL，肝肿瘤体积 466（45~558）mL，拟切除肝体积为 595（108~806）mL。28 例患者均行肿瘤根治性切除术，实际手术路径及方式与术前手术规划符合率 100%。术中出血量和输血量中位数分别为 700（100~2 000）mL 和 600（0~1 400）mL，输血率为 71.42%（20/28），并发症发生率为28.57%（8/28），术后无严重肝功能不全病例，住院病死率为 0。
结论：3D 可视化技术可以计算剩余肝脏体积，并可提高中央型肝肿瘤肝切除手术前规划的准确率及帮助术中精确操作。
Clinical application of 3D technology in preoperative surgical planning for central liver tumor
CorrespondingAuthor:Linquan WU Email: wulqnc@163.com
Abstract
Objective: To investigate the application value of 3D visualization technique in the preoperative planning of patients with central liver tumor.
Methods: The clinical data of 28 patients with central liver tumor that underwent preoperative evaluation by 3D visualization technique during January 2016 to November 2017 were analyzed retrospectively. Before operation, the two-dimensional CT images of the patients were obtained and imported into 3D visualization software. In the liver, hepatic artery system, portal vein system, hepatic venous system and tumor, image segmentations and 3D reconstructions were performed respectively. Then the subsection of the liver, the classification of the central liver tumor and calculation of the individual liver volume were performed. Based on the results of 3D reconstruction, the surgical planning was made, and the rational surgical approaches and procedures were selected.
Results: The 3D visualization model was successfully established in all of the 28 patients. The anatomies of the intrahepatic vascular system and the exact site, size and adjacent relations of the tumor were displayed, and the individual liver segmentation and classification of the central liver tumor were made through 3D technique. The median total liver volume was 1 532 (1 025–1 864) mL, volume of liver tumor was 466 (45–558) mL and volume of virtual resection liver was 595(108~806) mL. Radical resection of tumor was performed in all of the 28 patients. The coincidence rate between the actual surgical approaches and preoperative surgical planning was 100%. The median intraoperative blood loss and amount of blood transfusion were 700 (100–2 000) mL and 600 (0–1400) mL, the rate of blood transfusion was 71.42% (20/28) and the incidence of complications was 28.57% (8/28). No postoperative liver failure occurred and the in-hospital mortality rate was 0.
Conclusion: 3D visualization technique can calculate the volume of residual liver, improve the accuracy and safety of the preoperative planning of hepatectomy for central liver tumor, and is helpful for the precise operation during surgery.
Keywords：
Liver Neoplasms; Hepatectomy; Imaging
Three-Dimensional
Methods: The clinical data of 28 patients with central liver tumor that underwent preoperative evaluation by 3D visualization technique during January 2016 to November 2017 were analyzed retrospectively. Before operation, the two-dimensional CT images of the patients were obtained and imported into 3D visualization software. In the liver, hepatic artery system, portal vein system, hepatic venous system and tumor, image segmentations and 3D reconstructions were performed respectively. Then the subsection of the liver, the classification of the central liver tumor and calculation of the individual liver volume were performed. Based on the results of 3D reconstruction, the surgical planning was made, and the rational surgical approaches and procedures were selected.
Results: The 3D visualization model was successfully established in all of the 28 patients. The anatomies of the intrahepatic vascular system and the exact site, size and adjacent relations of the tumor were displayed, and the individual liver segmentation and classification of the central liver tumor were made through 3D technique. The median total liver volume was 1 532 (1 025–1 864) mL, volume of liver tumor was 466 (45–558) mL and volume of virtual resection liver was 595(108~806) mL. Radical resection of tumor was performed in all of the 28 patients. The coincidence rate between the actual surgical approaches and preoperative surgical planning was 100%. The median intraoperative blood loss and amount of blood transfusion were 700 (100–2 000) mL and 600 (0–1400) mL, the rate of blood transfusion was 71.42% (20/28) and the incidence of complications was 28.57% (8/28). No postoperative liver failure occurred and the in-hospital mortality rate was 0.
Conclusion: 3D visualization technique can calculate the volume of residual liver, improve the accuracy and safety of the preoperative planning of hepatectomy for central liver tumor, and is helpful for the precise operation during surgery.