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三维重建技术在评估大肝癌手术安全性中的作用

Safety assessment of hepatectomy for huge hepatocellular carcinoma by three dimensional reconstruction technique

摘要:

目的 探讨三维重建技术在大肝癌手术安全性评估中的作用.方法 回顾性分析2013年1月至2015年12月在华中科技大学同济医学院附属同济医院行手术治疗的28例肿瘤最大径>10 cm的肝癌患者资料.术前均行CT增强薄层扫描,采用IQQA-Liver肝脏CT影像解读分析系统对患者的CT影像进行三维重建,计算肝脏体积(LV)、标准肝脏体积(SLV)、肿瘤体积(TV)、功能性肝脏体积(FLV)、切除肝脏体积(ELV)、切除功能性肝脏体积(EFLV)、剩余功能性肝脏体积(RFLV)、实际切除肝脏体积(AELV),并计算RFLV/LV、RFLV/FLV和RFLV/SLV的值,并与术中实际手术方案及AELV对比.统计术后并发症发生率及病死率.ELV与AELV的比较采用配对student-t检验;采用Spearman检验分析TV与EFLV、RFLV、RFLV/FLV和RFLV/SLV的相关性.结果 28例患者的TV为202~2 125 cm3,RELV为401 ~1 633 cm3;13例RFLV/LV< 30%,所有患者的RFLV/FLV均>30.0% (34.8% ~ 94.0%),RFLV/SLV为35.9% ~ 139.0%.术前模拟肝切除手术方案与实际手术方案吻合率为100%,三维重建计算的ELV与AELV的差异无统计学意义(t=0.636,P>0.05).Spearman相关性检验结果显示,TV与EFLV呈负相关(r=-0.539,P<0.01),与RVLV、RFLV/FLV和RFLV/SLV呈正相关(r=0.641、0.629和0.732,P值均<0.01).28例患者术后均未发生肝性脑病、肝功能衰竭等严重并发症,无围手术期死亡.结论 三维重建技术可以精确模拟肝脏切除手术步骤,并计算剩余肝脏体积;TV越大,解剖性肝切除时EFLV越小,RFLV越大.

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abstracts:

Objective To explore the effectiveness of three-dimentional (3D) reconstruction technique in safety assessment of hepatectomy for large hepatocellular carcinoma (HCC).Methods The clinical records of 28 patients who underwent resection of HCC greater than 10 cm in diameter from January 2013 to December 2015 at Department of Hepatic Surgery,Tongji Hospital,Tongji Medical College Huazhong University of Science and Technology were studied retrospectively.All patients underwent enhanced computer tomography (CT),then 3D images of liver and tumor were reconstructed by uploading the CT imaging data to IQQA-Liver system.The individual surgery plan was simulated and liver volume (LV),standard liver volume (LV),tumor volume (TV),functional liver volume (FLV),excised liver volume(ELV),excised functional liver volume (EFLV),residual functional liver volume (RELV) were calculated.Simulated surgery plans were compared with actual procedures.ELV was compared with actual excised liver volume (AELV) by paired Student's t test.Postoperative complications and motility were analyzed.The correlation between TV and EFLV,RFLV,RFLV/FLV,RFLV/SLV were calculated by Spearman test.Results TV ranged from 202 cm3 to 2 125 cm3,RELV ranged from 401 cm3 to 1 633 cm3.There were 13 patients whose RFLV/LV < 30% and 28 patients whose RFLV/FLV > 30% (34.8%-94.0%).RFLV/SLV ranged from 35.9% to 139.0%.All simulated surgery plans matched with the actual operation procedure.ELV was equal to AELV,which confirmed by the high precision of IQQA-Liver system(t =0.636,P > 0.05).No severe complications (hepatic encephalopathy or liver failure) and perioperativedeath occurred after operation.Positive correlation was observed between TV and RFLV,TV and RFLV/FLV,TV and RFLV/SLV(r =0.641,0.629 and 0.732,all P <0.01).Negative correlation was observedbetween TV and EFLV (r =-0.539,P < 0.01).Conclusions 3D reconstruction technique couldaccurately simulate surgery procedure,calculate liver volume and evaluate the safety of hepatectomy for hugehepatocellular carcinoma.When the anatomical liver resection was performed,the larger tumor volumemeans the smaller excision functional liver volume and larger residual liver volume.

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作者: 陈琳 [1] 罗鸿萍 [1] 董水林 [1] 陈孝平 [1]
第一作者: 陈琳
期刊: 《中华外科杂志》2016年54卷9期 669-674页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2016.09.005
发布时间: 2016-09-30
基金项目:
“十二五”国家科技重大专项项目 National Science and Technology Major Project of China
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