中国普外基础与临床杂志

中国普外基础与临床杂志

计算机三维可视化重建技术在肝泡型包虫病切除术中的应用

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目的 评估计算机三维可视化重建系统在肝泡型包虫病切除术中的应用及不足。 方法 回顾性分析 2014 年 1 月至 2016 年 12 月期间在四川大学华西医院肝脏外科接受手术切除治疗的 152 例肝泡型包虫病患者的临床资料,其中切除范围≥4 个肝段患者 80 例,切除范围≤3 个肝段患者 72 例,不同肝切除范围患者根据是否进行了三维重建分为三维重建组和未三维重建组,记录并比较三维重建组和未三维重建组患者的影像学数据、术中指标及术后情况。 结果 共有 79 例肝泡型包虫病患者进行了三维可视化重建并生成了实时的三维模型,三维可视化重建时间平均 19 min,其中有 13 例患者重建时间超过了 30 min,最长者达到了 150 min。在根据三维重建结果拟定手术方案的 79 例患者中,术前模拟手术预计切除肝脏体积为(583.6±374.7)mL,术中实际切除肝脏体积为(573.8±406.3)mL,二者比较一致(P=0.640)。切除范围≥4 个肝段和≤3 个肝段患者中分别有 41 例和 38 例选择进行了三维重建。切除范围≥4 个肝段患者中,三维重建组的手术时间明显短于未三维重建组(P=0.021),术中出血量也明显少于未三维重建组(P=0.047),2 组患者间术中输血情况比较差异无统计学意义(P=0.766)。切除范围≤3 个肝段患者中,三维重建组和未三维重建组患者的手术时间、术中出血量及术中输血情况比较差异均无统计学意义(P>0.05)。无论是切除范围≥4 个肝段或是≤3 个肝段患者的三维重建组和未三维重建组间术后 3 d 内的实验室检查结果、术后 90 d 内的并发症发生情况及住院时间比较差异均无统计学意义(P>0.05)。 结论 计算机三维可视化重建系统可以减少≥4 个肝段切除术肝泡型包虫病患者的术中出血量及缩短手术时间,但其在≤3 个肝段切除术肝泡型包虫病患者中则没有明显获益。

Objective To evaluate effects of three-dimensional (3D) visualized reconstruction technology on short-term benefits of different extent of resection in treating hepatic alveolar echinococcosis (HAE) as well as some disadvantages. Methods One hundred and fifty-two patients with HAE from January 2014 to December 2016 in the Department Liver Surgery, West China Hospital of Sichuan University were collected, there were 80 patients with ≥4 segments and 72 patients with ≤3 segments of liver resection among these patients, which were designed to 3D reconstruction group and non-3D reconstruction group according to the preference of patients. The imaging data, intraoperative and postoperative indicators were recorded and compared. Results The 3D visualized reconstructions were performed in the 79 patients with HAE, the average time of 3D visualized reconstruction was 19 min, of which 13 cases took more than 30 min and the longest reached 150 min. The preoperative predicted liver resection volume of the 79 patients underwent the 3D visualized reconstruction was (583.6±374.7) mL, the volume of intraoperative actual liver resection was (573.8±406.3) mL, the comparison of preoperative and intraoperative data indicated that both agreed reasonably well (P=0.640). Forty-one cases and 38 cases in the 80 patients with ≥4 segments and 72 patients with ≤3 segments of liverresection respectively were selected for the 3D visualized reconstruction. For the patients with ≥4 segments of liver resection, the operative time was shorter (P=0.021) and the blood loss was less (P=0.047) in the 3D reconstruction group as compared with the non-3D reconstruction group, the status of intraoperative blood transfusion had no significant difference between the 3D reconstruction group and the non-3D reconstruction group (P=0.766). For the patients with ≤3 segments of liver resection, the operative time, the blood loss, and the status of intraoperative blood transfusion had no significant differences between the 3D reconstruction group and the non-3D reconstruction group (P>0.05). For the patients with ≥4 segments or ≤3 segments of liver resection, the laboratory examination results within postoperative 3 d, complications within postoperative 90 d, and the postoperative hospitalization time had no significant differences between the 3D reconstruction group and the non-3D reconstruction group (P>0.05). Conclusion 3D visualized reconstruction technology contributes to patients with HAE ≥4 segments of liver resection, it could reduce intraoperative blood loss and shorten operation time, but it displays no remarkable benefits for ≤3 segments of liver resection.

关键词: 肝泡型包虫病; 肝切除; 三维重建; 术前规划; 精准外科

Key words: hepatic alveolar echinococcosis; liver resection; three-dimensional reconstruction; surgical planning; precision surgery

引用本文: 邱逸闻, 杨先伟, 沈舒, 王文涛. 计算机三维可视化重建技术在肝泡型包虫病切除术中的应用. 中国普外基础与临床杂志, 2018, 25(5): 540-546. doi: 10.7507/1007-9424.201711109 复制

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