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肝门部胆管癌三维可视化精准诊疗平台构建及临床应用

The construction of three-dimensional visualization platform and its application in diagnosis and treatment for hilar cholangiocarcinoma

摘要:

目的 探讨肝门部胆管癌三维可视化精准诊治平台的构建及临床应用价值.方法 回顾性收集2009年1月至2015年12月南方医科大学珠江医院肝胆一科诊治的32例术前构建三维重建模型的肝门部胆管癌患者资料.男性20例,女性12例;年龄40~85岁,平均62岁.Bismuth-Corlette三维可视化分型:Ⅰ型2例、Ⅱ型5例、Ⅲa型10例、Ⅲb型11例、Ⅳ型4例.记录患者的手术时间、失血量、实验室检验结果和术后并发症.其中5例患者进行了肝脏三维打印技术辅助的术中实时导航.根据患者的诊治流程构建肝门部胆管癌三维可视化精准诊治平台.结果 本组患者均成功构建三维可视化模型,可清楚显示肝内各管道、肿瘤大小和位置、肿瘤与肝内管道的解剖关系;肝脏三维打印模型形象逼真,立体感强,能实时导航手术.根据Bismuth-Corlette分型,其中Ⅰ型2例行肿瘤局部切除,胆肠吻合术;Ⅱ型5例行肝脏4b段切除、5段部分切除、1段切除,胆肠吻合术;Ⅲa型10例行右半肝切除、肝脏1段切除,胆肠吻合术;Ⅲb型11例行左半肝切除、肝脏1段切除,胆肠吻合术;Ⅳ型4例行肝脏4b段肝切除、5段切除,胆肠吻合术.手术时间270 ~660 min,术中失血量588 ml,平均术后住院时间25 d,平均术后第3天总胆红素水平233 μmol/L.术后出现胆漏1例,经通畅引流内科治疗治愈;无肝功能衰竭及围手术期死亡病例.结论 肝门部胆管癌三维可视化诊治平台实现了术前精确诊断,尤其在肝内管道变异的情况下,有助于术中精准操作、提高手术成功率.

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abstracts:

Objective To explore the construction and clinical efficacy of three-dimensional (3D) visualization platform about diagnosis and treatment of hilar cholangiocarcinoma.Methods From January 2009 to December 2015,a total of 32 patients with hilarcholangiocarcinoma treated in Zhujiang Hospital of Southern Medical University were analyzed.There were 20 male and 12 female patients aged from 40 to 85 years.Bismuth-Corlette 3D visualization type:2 cases with type Ⅰ,5 cases with type Ⅱ,10 cases with type Ⅲ a,11 cases with type Ⅲ b,4 cases with type Ⅳ.Among 32 cases,there were 5 cases who were established liver 3D printing models to guide intraoperative real-time navigation.The clinical effect of this platform was evaluated by the operation time,intraoperative blood loss,laboratory test and postoperative complications.The 3D visualization platform consists of the preoperative surgical planning with the aid of virtual 3D reconstruction technology and intraoperative real-time navigation with 3D printing models.Results The liver 3D models for all patients were constructed successfully,they could clearly show intrahepatic pipeline,size and location of tumors,relationship between tumor and intrahepatic pipeline.The 3D printing models could accomplish real-time intraoperative navigation surgery with strong stereoscopic sense.According to Bismuth classification 3D visualization type,2 patients with type Ⅰ received local excision of tumor and choledochojejunostomy;5 patients with type Ⅱ received resection of segment Ⅰ,Ⅳ b and partial Ⅴ combined with choledochojejunostomy;10 patients with type Ⅲ a received right semi-hepatectomy combined with resection of segment Ⅰ and choledochojejunostomy;11 cases with type Ⅲ b received left semihepatectomy combined with resection of segment Ⅰ and choledochojejunostomy;4 cases with type Ⅳ received resection of segment Ⅳ b and Ⅴ combined with choledochojejunostomy.The operation time was 270-660 minutes;the mean intraoperative blood loss was 588 ml;the mean postoperative hospital stay was 25 days.The bilirubin level three day after operation was 233 μmol/L.There was 1 case presented biliary fistula and cured by conservative treatment;there was no incision infection,no liver failure and no perioperative deaths occurred.Conclusion The 3D visualization is valuable for optimizing the operation scheme preoperatively and navigating surgery accurately intraoperatively in real-time which may improve the precision of the operation and achieve better the recovery.

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作者: 曾宁 [1] 方驰华 [1] 范应方 [1] 杨剑 [1] 项楠 [1] 祝文 [1] 刘军 [1] 蔡伟 [2] 莫志康 [2]
第一作者: 曾宁
作者单位: 南方医科大学珠江医院肝胆一科, 广州,510282 [1] 广东省数字医学临床工程技术研究中心 [2]
期刊: 《中华外科杂志》2016年54卷9期 680-685页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2016.09.007
发布时间: 2016-09-30
基金项目:
国家高技术研究发展(863)计划项目 NSFC-广东省联合基金 National High Technology Research and Development (863) Program NSFC-Guangdong United Funds
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