CT三维重建可视化系统在原发性肝癌肝切除中的应用
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摘要
目的探讨CT扫描三维重建可视化系统对原发性肝癌(肝癌)手术规划和术中指导的临床意义。方法回顾性分析2016年3月至2017年3月解放军总医院收治的46例肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。根据术前评估方式将患者分为可视化组和对照组,可视化组男18例,女5例,平均年龄(61±9)岁;对照组男16例,女7例,年龄(60±9)岁。所有患者术前诊断均为肝癌。可视化组术前采用CT扫描三维重建可视化系统评估患者情况。观察两组患者在术式选择、手术时间、术中出血量以及术后并发症等方面的不同。手术时间、术中出血量等比较采用t检验,率的比较采用χ~2检验,相关性分析采用Pearson相关分析。结果三维重建可视化系统可准确显示肿瘤与脉管系统的关系,并发现解剖变异。可视化组患者的微创手术率为48%(11/23),明显高于对照组的17%(4/23)(χ~2=4.85,P<0.05)。可视化组手术时间、术中出血量、住院时间分别为(128±38)min、(135±67)ml、(7.7±2.3)d,明显少于对照组的(205±56)min、(270±83)ml、(10.9±2.0)d(t=-5.37,-3.31,-4.92;P<0.05)。可视化组术后ALT、TB分别为(205±96)U/L、(12.2±2.4)μmol/L,明显低于对照组的(302±136)U/L、(18.5±3.8)μmol/L(t=-2.81,-6.67;P<0.05)。可视化组术前虚拟肝切除体积为(483±30)ml,与术中实际肝切除体积(437±30)ml,差异无统计学意义(t=1.13,P>0.05),二者呈正相关关系(r=0.814,P<0.05)。结论 CT三维重建可视化系统有助于肝癌患者术前安全性评估,关键解剖部位的定位及手术方案优化,指导精准肝切除。
Objective To explore the clinical significance of CT three-dimensional reconstruction visualization system for surgical planning and intraoperative guidance for primary liver cancer(PLC). Methods Clinical data of 46 patients with PLC admitted to Chinese PLA General Hospital from March 2016 to March 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the visualization(n=23) and control groups(n=2). In visualization group, 18 patients were male and 5 were female with an average age of(61±9) years. In control group, 16 cases were male and 7 were female, aged(60±9) years on average. All patients were diagnosed with liver cancer before operation. In visualization group, CT D reconstruction visualization system was used for accessing the condition of patients before operation. The surgical procedure, operation time, intraoperative blood loss and postoperative complications of two groups were observed. The operation time and intraoperative blood loss were compare by t test. The rate comparison was conducted by Chi-square test. Correlation analysis was performed by Pearson correlation analysis. Results D reconstruction visualization system could precisely display the relationship between tumors and vasculature and identify the anatomical variations. In visualization group, the percentage of undergoing minimally invasive surgery was 48%(11/23), significantly higher than 17%(4/23) in control group(χ~2=4.85,P<0.05). In visualization group, the intraoperative operation time, blood loss and length of hospital stay were(128±38) min,(135±67) ml and(7.7±2.3) d, significantly less than(205±56) min,(270±83) ml and(10.9±2.0) d in control group(t=-5.37,-3.31,-4.92; P<0.05). The postoperative levels of ALT and TB in visualization group were(205±96) U/L and(12.2±2.4) μmol/L, significantly lower than(302±136) U/L and(18.5±3.8) μmol/L in the control group(t=-2.81,-6.67; P<0.05). In visualization group, the estimated volume of resected liver before operation was(483±30) ml, where no significant difference was observed compared with the actual intraoperative resected liver volume(437±30) ml(t=1.13, P>0.05), and a positive correlation was observed between them(r=0.814, P<0.05). Conclusions CT D reconstruction visualization system is useful for preoperative safety assessment, locating the key anatomical parts, optimizing surgical plans so as to conduct the precise hepatectomy.
Objective To explore the clinical significance of CT three-dimensional reconstruction visualization system for surgical planning and intraoperative guidance for primary liver cancer(PLC). Methods Clinical data of 46 patients with PLC admitted to Chinese PLA General Hospital from March 2016 to March 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the visualization(n=23) and control groups(n=2). In visualization group, 18 patients were male and 5 were female with an average age of(61±9) years. In control group, 16 cases were male and 7 were female, aged(60±9) years on average. All patients were diagnosed with liver cancer before operation. In visualization group, CT D reconstruction visualization system was used for accessing the condition of patients before operation. The surgical procedure, operation time, intraoperative blood loss and postoperative complications of two groups were observed. The operation time and intraoperative blood loss were compare by t test. The rate comparison was conducted by Chi-square test. Correlation analysis was performed by Pearson correlation analysis. Results D reconstruction visualization system could precisely display the relationship between tumors and vasculature and identify the anatomical variations. In visualization group, the percentage of undergoing minimally invasive surgery was 48%(11/23), significantly higher than 17%(4/23) in control group(χ~2=4.85,P<0.05). In visualization group, the intraoperative operation time, blood loss and length of hospital stay were(128±38) min,(135±67) ml and(7.7±2.3) d, significantly less than(205±56) min,(270±83) ml and(10.9±2.0) d in control group(t=-5.37,-3.31,-4.92; P<0.05). The postoperative levels of ALT and TB in visualization group were(205±96) U/L and(12.2±2.4) μmol/L, significantly lower than(302±136) U/L and(18.5±3.8) μmol/L in the control group(t=-2.81,-6.67; P<0.05). In visualization group, the estimated volume of resected liver before operation was(483±30) ml, where no significant difference was observed compared with the actual intraoperative resected liver volume(437±30) ml(t=1.13, P>0.05), and a positive correlation was observed between them(r=0.814, P<0.05). Conclusions CT D reconstruction visualization system is useful for preoperative safety assessment, locating the key anatomical parts, optimizing surgical plans so as to conduct the precise hepatectomy.
引文
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[15]李连海,王建伟,刘斌,等.三维重建在肝切除术前评估中的临床应用效果[J].临床肝胆病杂志,2016,32(5):938-941.
[16]Xiang N,Fang C,Fan Y,et al.Application of liver three-dimensional printing in hepatectomy for complex massive hepatocarcinoma with rare variations of portal vein:preliminary experience[J].Int J Clin Exp Med,2015,8(10):18873-18878.
[17]Takagi K,Nanashima A,Abo T,et al.Three-dimensional printing model of liver for operative simulation in perihilar cholangiocarcinoma[J].Hepatogastroenterology,2014,61(136):2315-2316.
[18]方驰华,方兆山,范应方,等.三维可视化、3D打印及3D腹腔镜在肝肿瘤外科诊治中的应用[J].南方医科大学学报,2015(5):639-645.
[19]张朋飞,于松宁,雷鹏,等.3D打印技术在精准肝切除术前评估的应用[J].中国普通外科杂志,2017,26(7):831-837.
[20]杨华瑜,廖文俊,桑新亭,等.3D打印技术在医学和肝胆外科中的应用[J].肝胆外科杂志,2016,24(1):66-68.
[21]Mise Y,Tani K,Aoki T,et al.Virtual liver resection:computerassisted operation planning using a three-dimensional liver representation[J].J Hepatobiliary Pancreat Sci,2013,20(2):157-164.
[22]Schroeder T,Radtke A,Kuehl H,et al.Evaluation of living liver donors with an all-inclusive 3D multi-detector row CT protocol[J].Radiology,2006,238(3):900-910.
[23]Ulla M,Ardiles V,Levy-Yeyati E,et al.New surgical strategy to induce liver hypertrophy:role of MDCT-volumetry to monitor and predict liver growth[J].Hepatogastroenterology,2013,60(122):337-342.
[24]黄志强,黄晓强.黄志强肝脏外科手术学[M].北京:人民军医出版社,2007:460.2018-08-07
[2]周林,郑永根,杜国盛,等.肝癌肝移植术后西罗莫司转换治疗的免疫学效应分析[J].解放军医药杂志,2017,29(4):24-28.
[3]周林,郑永根,杜国盛.索拉非尼防治肝癌肝移植术后复发的研究进展[J].器官移植,2014(5):270-276,307.
[4]Liaw CY,Guvendiren M.Current and emerging applications of 3Dprinting in medicine[J].Biofabrication,2017,9(2):024102.
[5]董家鸿,叶晟.开启精准肝胆外科的新时代[J/CD].中华普外科手术学杂志(电子版),2016,10(3):181-184.
[6]Ventola CL.Medical applications for 3D printing:current and projected uses[J].P T,2014,39(10):704-711.
[7]Thomas MB,Jaffe D,Choti MM,et al.Hepatocellular carcinoma:consensus recommendations of the National Cancer Institute Clinical Trials Planning Meeting[J].J Clin Oncol,2010,28(25):3994-4005.
[8]Venook AP,Papandreou C,Furuse J,et al.The incidence and epidemiology of hepatocellular carcinoma:a global and regional perspective[J].Oncologist,2010,15 Suppl 4:5-13.
[9]周林,潘立超,史宪杰,等.MELD评价体系对肝移植受者选择的多中心临床研究进展[J].器官移植,2017,8(2):174-178.
[10]祝文,方驰华,范应方,等.原发性肝癌三维可视化诊治平台的构建及临床应用[J/CD].中华肝脏外科手术学电子杂志,2015,4(5):268-273.
[11]董家鸿,杨世忠.现代科技在精准肝切除中的综合应用[J].肝胆外科杂志,2010,18(1):57-59.
[12]Igami T,Nakamura Y,Hirose T,et al.Application of a threedimensional print of a liver in hepatectomy for small tumors invisible by intraoperative ultrasonography:preliminary experience[J].World J Surg,2014,38(12):3163-3166.
[13]Zein NN,Hanouneh IA,Bishop PD,et al.Three-dimensional print of a liver for preoperative planning in living donor liver transplantation[J].Liver Transpl,2013,19(12):1304-1310.
[14]董家鸿,杨世忠.现代科技在精准肝切除中的综合应用[J].肝胆外科杂志,2010,18(1):57-59.
[15]李连海,王建伟,刘斌,等.三维重建在肝切除术前评估中的临床应用效果[J].临床肝胆病杂志,2016,32(5):938-941.
[16]Xiang N,Fang C,Fan Y,et al.Application of liver three-dimensional printing in hepatectomy for complex massive hepatocarcinoma with rare variations of portal vein:preliminary experience[J].Int J Clin Exp Med,2015,8(10):18873-18878.
[17]Takagi K,Nanashima A,Abo T,et al.Three-dimensional printing model of liver for operative simulation in perihilar cholangiocarcinoma[J].Hepatogastroenterology,2014,61(136):2315-2316.
[18]方驰华,方兆山,范应方,等.三维可视化、3D打印及3D腹腔镜在肝肿瘤外科诊治中的应用[J].南方医科大学学报,2015(5):639-645.
[19]张朋飞,于松宁,雷鹏,等.3D打印技术在精准肝切除术前评估的应用[J].中国普通外科杂志,2017,26(7):831-837.
[20]杨华瑜,廖文俊,桑新亭,等.3D打印技术在医学和肝胆外科中的应用[J].肝胆外科杂志,2016,24(1):66-68.
[21]Mise Y,Tani K,Aoki T,et al.Virtual liver resection:computerassisted operation planning using a three-dimensional liver representation[J].J Hepatobiliary Pancreat Sci,2013,20(2):157-164.
[22]Schroeder T,Radtke A,Kuehl H,et al.Evaluation of living liver donors with an all-inclusive 3D multi-detector row CT protocol[J].Radiology,2006,238(3):900-910.
[23]Ulla M,Ardiles V,Levy-Yeyati E,et al.New surgical strategy to induce liver hypertrophy:role of MDCT-volumetry to monitor and predict liver growth[J].Hepatogastroenterology,2013,60(122):337-342.
[24]黄志强,黄晓强.黄志强肝脏外科手术学[M].北京:人民军医出版社,2007:460.2018-08-07
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