数字化三维重建技术在肝癌精准肝切除术中的应用
| 作者: |
1白军军,
1李航,
1孙宝震,
1翟振洪,
1季德刚
1 吉林大学中日联谊医院 肝胆胰外科，吉林 长春 130021 |
| 通讯: |
季德刚
Email: jidegangh@163.com |
| DOI: | 10.3978/.2018.07.005 |
| 基金: | 吉林省科技发展计划基金资助项目（20150204082SF）。 |
摘要
目的：探讨数字化三维重建技术在肝癌精准肝切除术中的临床应用。
方法：选择 2015 年 10 月—2017 年 10 月收治的 21 例原发性肝癌（肿瘤直径 >5 cm）患者，术前行肝脏 CT 平扫加增强检查，利用 Myrian 三维重建软件对肝脏进行三维重建处理，对患者肝内血管，肿瘤位置、大小及两者的毗邻关系进行分析，计算全肝体积（TLV）、标准肝体积（SLV）、功能性肝体积（FLV）、肿瘤体积（TuV）、拟切除肝体积（vRLV）、拟切除标本体积（vRSV）及残肝体积（RLV），并测量术中实际切除标本重量（aRSW）及标本体积（aRSV），检验 vRSV 的准确性并对 vRSV、aRSV及 aRSW 进行相关性分析。
结果：21 例患者 TLV 为（1 827.9±314.8）cm3，TuV 为（593.4±283.2）cm3，vRLV 为（511.2± 180.0）cm3，vRSV 为（1 104.6±292.3）cm3。术后测量 aRSW 为（1 212.9±278.46）g，用排水法测量 aRSV 为（1 101.0±280.4）cm3。vRSV 与 aRSV 比较无统计学意义（P=0.76）。Pearson 相关性分析显示 aRSV 与 vRSV、aRSW 与 vRSV、aRSW 与 aRSV 之间呈高度正相关（r=0.9964、0.9201、0.9345，均 P<0.0001）。术前虚拟手术方案与实际手术方案均吻合，术后 21 例均未出现肝性脑病及肝功能衰竭，围手术期无病例死亡。
结论：术前行肝脏三维重建结合肝功能评估，对肿瘤精确定位、自动化分割、定量分析，特别是肝体积计算和虚拟肝切除术对肝癌精准肝切除术的手术方案选择有重要价值。
关键词：
肝肿瘤；肝切除术；成像，三维；计算机模拟
方法：选择 2015 年 10 月—2017 年 10 月收治的 21 例原发性肝癌（肿瘤直径 >5 cm）患者，术前行肝脏 CT 平扫加增强检查，利用 Myrian 三维重建软件对肝脏进行三维重建处理，对患者肝内血管，肿瘤位置、大小及两者的毗邻关系进行分析，计算全肝体积（TLV）、标准肝体积（SLV）、功能性肝体积（FLV）、肿瘤体积（TuV）、拟切除肝体积（vRLV）、拟切除标本体积（vRSV）及残肝体积（RLV），并测量术中实际切除标本重量（aRSW）及标本体积（aRSV），检验 vRSV 的准确性并对 vRSV、aRSV及 aRSW 进行相关性分析。
结果：21 例患者 TLV 为（1 827.9±314.8）cm3，TuV 为（593.4±283.2）cm3，vRLV 为（511.2± 180.0）cm3，vRSV 为（1 104.6±292.3）cm3。术后测量 aRSW 为（1 212.9±278.46）g，用排水法测量 aRSV 为（1 101.0±280.4）cm3。vRSV 与 aRSV 比较无统计学意义（P=0.76）。Pearson 相关性分析显示 aRSV 与 vRSV、aRSW 与 vRSV、aRSW 与 aRSV 之间呈高度正相关（r=0.9964、0.9201、0.9345，均 P<0.0001）。术前虚拟手术方案与实际手术方案均吻合，术后 21 例均未出现肝性脑病及肝功能衰竭，围手术期无病例死亡。
结论：术前行肝脏三维重建结合肝功能评估，对肿瘤精确定位、自动化分割、定量分析，特别是肝体积计算和虚拟肝切除术对肝癌精准肝切除术的手术方案选择有重要价值。
Application of digital 3D reconstruction technique in precise hepatectomy for liver cancer
CorrespondingAuthor:Degang JI Email: jidegangh@163.com
Abstract
Objective: To investigate the clinical application of digital three-dimensional reconstruction technique in precise hepatectomy for liver cancer.
Methods: Twenty one patients with primary liver cancer (tumor diameter >5 cm) treated from October 2015 to October 2017 were selected. All patients underwent plain and contrast enhanced CT scan of the liver before operation. Th ree-dimensional reconstruction of the liver was performed by Myrian reconstruction soft ware. Th e intrahepatic vessels, location and size of the tumor and their relationship in the patients were analyzed, and the total liver volume (TLV), standard liver volume (SLV), functional liver volume (FLV), tumor volume (TuV), virtual resection liver volume (vRLV), virtual resection specimen volume (vRSV) and residual liver volume (RLV) were calculated. The intraoperative actual specimen weight (aRSW) and actual specimen volume (aRSV) were determined. After that, the accuracy of vRSV was examined and analyzed and the correlations among vRSV, aRSV and aRSW were analyzed.
Results: In the 21 patients, the TLV was (1 827.9±314.8) cm3, TuV was (593.4±283.2) cm3, vRLV was (511.2±180.0) cm3 and vRSV was (1 104.6±292.3) cm3; the aRSW obtained after operation was (1 212.9±278.46) g. There was no significant difference between vRSV and aRSV (P=0.76). Pearson test showed that there were significantly positive correlation between aRSV and vRSV, aRSW and vRSV and aRSW and aRSV (r=0.9 964, 0.9 201, 0.9 345, all P<0.0 001). The preoperative virtual surgery simulations were consistent with the actual surgical protocols. None of the 21 patients had hepatic encephalopathy or liver failure after operation, and no death occurred during the perioperative period.
Conclusion: The three-dimensional reconstruction of liver combined with liver function assessment before operation has great value for surgical procedure selection of precise liver cancer resection, for its precise tumor positioning, automatic segmentation and quantitative analysis, especially liver volume calculation and virtual liver resection.
Keywords：
Liver Neoplasms; Hepatectomy; Imaging
Three-Dimensional; Computer Simulation
Methods: Twenty one patients with primary liver cancer (tumor diameter >5 cm) treated from October 2015 to October 2017 were selected. All patients underwent plain and contrast enhanced CT scan of the liver before operation. Th ree-dimensional reconstruction of the liver was performed by Myrian reconstruction soft ware. Th e intrahepatic vessels, location and size of the tumor and their relationship in the patients were analyzed, and the total liver volume (TLV), standard liver volume (SLV), functional liver volume (FLV), tumor volume (TuV), virtual resection liver volume (vRLV), virtual resection specimen volume (vRSV) and residual liver volume (RLV) were calculated. The intraoperative actual specimen weight (aRSW) and actual specimen volume (aRSV) were determined. After that, the accuracy of vRSV was examined and analyzed and the correlations among vRSV, aRSV and aRSW were analyzed.
Results: In the 21 patients, the TLV was (1 827.9±314.8) cm3, TuV was (593.4±283.2) cm3, vRLV was (511.2±180.0) cm3 and vRSV was (1 104.6±292.3) cm3; the aRSW obtained after operation was (1 212.9±278.46) g. There was no significant difference between vRSV and aRSV (P=0.76). Pearson test showed that there were significantly positive correlation between aRSV and vRSV, aRSW and vRSV and aRSW and aRSV (r=0.9 964, 0.9 201, 0.9 345, all P<0.0 001). The preoperative virtual surgery simulations were consistent with the actual surgical protocols. None of the 21 patients had hepatic encephalopathy or liver failure after operation, and no death occurred during the perioperative period.
Conclusion: The three-dimensional reconstruction of liver combined with liver function assessment before operation has great value for surgical procedure selection of precise liver cancer resection, for its precise tumor positioning, automatic segmentation and quantitative analysis, especially liver volume calculation and virtual liver resection.