三维可视化技术用于肝癌三维重建与术后测量的一致性分析

摘要/Abstract

摘要： 目的研究利用三维可视化技术实现肝癌术前三维重建模拟手术与实际手术情况的一致性。方法 2016年8月至2019年8月无锡市第五人民医院收治的原发性肝癌患者144例,均接受腹腔镜肝切除术治疗。所有患者术前均行上腹部螺旋CT平扫联合增强检查,获取原始CT结果后以医学数字成像和通信(DICOM)格式存储,利用三维可视化技术进行肝脏三维重建,并在三维重建后图像中拟定虚拟切除线,拟定手术方式。分析手术情况,比较术后切除肿瘤与术前三维重建计算所得结果,并分析预后情况。结果 144例患者均成功通过三维重建肝脏及肝内血管模型,经术前评估虚拟手术后有5例因肿瘤侵犯下腔静脉而无法耐受手术,行肝动脉造影＋化疗栓塞术;其余患者均成功实施肝切除手术,其中肝左外叶切除手术74例,第Ⅳ肝段切除术5例,第Ⅵ肝段切除15例,第Ⅶ、Ⅷ肝段切除术15例,右半肝切除术5例,左半肝切除术10例,不规则肝切除15例。139例肝切除患者术前基于三维可视化技术下测得全肝体积为(1 500.5±447.9)mL,虚拟肝切除体积为(507.8±184.4)mL,标准功能肝体积比值为(64.0±8.5)%;术后切除肿瘤获取实际肝切除体积为(523.0±175.8)mL。虚拟肝切除体积与实际肝切除体积呈正相关(r=0.949,P<0.001)。术后有13例患者出现并发症,均经对症治疗后好转出院。随诊3月未发现肿瘤复发及转移情况。结论三维重建可视化技术在肝切除术前评估中能准确预测肝切除范围,指导手术方案的制定。

关键词: 三维可视化技术, 肝癌, 三维重建, 肝切除术

Abstract: Objective To investigate the consistency between the simulated operation via three-dimensional (3D) visualization technology and the actual operation of liver cancer. Methods Between August 2016 and August 2019, 144 patients with primary liver cancer in our hospital were treated by laparoscopic hepatectomy. All patients had undergone preoperative non-enhanced and contrast-enhanced spiral computed tomography (CT) of the upper abdomen. The original CT images were stored in digital imaging and communications in medicine format. The surgical plan was based on 3D images of liver reconstructed by 3D visualization technology. The actual hepatectomy and prognosis were analyzed, and the volume of tumor were compared between actual hepatectomy and 3D reconstruction. Results All of 144 patients underwent 3D reconstruction of liver and intrahepatic vessels successfully. Five patients underwent transarterial chemoembolization, because preoperative evaluation showed their intolerance to the operation with tumor invading inferior vena cava. The rest underwent hepatectomy successfully, including 74 cases of left lateral hepatic lobectomy, 5 cases of IV segmentectomy, 15 cases of VI segmentectomy, 15 cases of Ⅶ and Ⅷ segmentectomy, 5 cases of right hepatic lobectomy, 10 cases of left hepatic lobectomy and 15 cases of irregular hepatectomy. In the 139 patients, the total liver volume of (1 500.5 ± 447.9) mL, the virtual liver resection volume of (507.8 ± 184.4) mL, and the remnant to standard functional liver volume ratio of (64.0 ± 8.5) % were calculated by 3D visualization technology before operation. The actual tumor volume measured (523.0 ± 175.8) mL after operation. There was a positive correlation between virtual and actual volume of hepatectomy (r=0.949, P<0.001). After operation, 13 patients had complications, all of whom improved to be discharged after symptomatic treatment. No tumor recurrence or metastasis was found during 3-month follow-up. Conclusion The application of 3D reconstruction visualization technology in preoperative evaluation helps to predict the scope of liver resection accurately and to guide the formulation of surgical plan.

Key words: Three-dimensional visualization technology, Liver cancer, Three-dimensional reconstruction, Hepatectomy

蔡明月, 江凯, 徐蒙莱, 蒋骏麟. 三维可视化技术用于肝癌三维重建与术后测量的一致性分析[J]. 肝脏, 2021, 26(3): 276-280.

CAI Ming-yue, JIANG Kai, XU Meng-lai, JIANG Jun-lin. Consistency analysis of liver tumor volume between 3D reconstruction via 3D visualization technology and postoperative measurement[J]. Chinese Hepatolgy, 2021, 26(3): 276-280.

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