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二维影像技术和三维可视化技术辅助ALPPS治疗肝癌效果的初步探讨

The application value of two-dimensional image technology and three-dimensional visualization technology in hepatocellular carcinoma treated by associating liver partition and portal vein ligation for staged hepatectomy:a preliminary study

摘要:

目的 初步探讨二维影像技术和三维可视化技术辅助联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)治疗肝癌的价值.方法 回顾性分析2013年8月至2015年5月中山大学孙逸仙纪念医院采用ALPPS治疗的19例肝癌患者的临床资料,其中15例采用传统二维影像学技术辅助术前评估、手术规划及术中指导(2D组),4例采用三维可视化技术(3D组)辅助.结果 三维可视化技术可获得准确、直观、清晰的三维图像,精确计算肝脏体积,实现术前虚拟仿真手术,协助术中决策的制定.2D组和3D组的第一步手术时间分别为(331.3 ±61.7)min和(261.3 ±21.4)min,出血量分别为(360.7±51.9) ml和(300.0±40.8) ml;第二步手术时间分别为(199.3±41.0) min和(170.0±29.4)min,出血量分别为(285.3±132.6)ml和(257.5±99.5)ml;两步手术时间间隔分别为(15.3±6.5)d和(13.8±5.1)d;住院时间分别为(39.3±5.8)d和(31.5±7.5)d;第二步手术完成率分别为12/15和4/4;术后肝功能衰竭的例数分别为7例(A级4例、B级2例、C级1例)和2例(A级1例、B级1例);术后分别发生并发症9例(Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为4、2、1、2例)和3例(Ⅰ、Ⅱ、Ⅲ级分别为1、1、1例);术后90 d分别死亡2例和0例;术后半年分别复发3例和1例;术后半年分别死亡4例和1例.结论 三维可视化技术有助于个体化、精准化的ALPPS术前评估及手术规划方案的制定,在辅助ALPPS治疗肝癌中具有潜在的应用价值.

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abstracts:

Objective To preliminarily explore the application value of two-dimensional image technology and three-dimensional visualization technology in hepatocellular carcinoma (HCC) treated by associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).Methods Clinical data of nineteen HCC patients treated by ALPPS were retrospectively analyzed in Sun-Yat-Sen Memorial Hospital of Sun Yat-Sen University from August 2013 to May 2015.Preoperative assessment,surgical planning and intraoperative guidance were assisted by traditional two-dimensional imaging technology (group 2D) in 15 cases,and the rest 4 cases were assisted by three-dimensional visualization technology (group 3D).Results Three-dimensional visualization technology offered precise,visual,and distinct images,calculated the liver volume precisely,achieved virtual simulation operations,and assisted the formulation of intraoperative decisions.The mean operation time of the first stage were (331.3 ± 61.7) minutes and (261.3 ± 21.4)minutes in group 2D and group 3 D,and the mean volume of intraoperative bleedings were (360.7 ± 51.9) ml and (300.0 ± 40.8) ml,respectively.The mean operation time of the second stage were (199.3 ± 41.0)minutes and (170.0 ± 29.4)minutes in group 2D and group 3D,and the mean volume of intraoperative bleedings were (285.3 ± 132.6) ml and (257.5 ± 99.5) ml,respectively.The mean interval time between two stages of operations were (15.3 ±6.5)d and (13.8 ±5.1)d in group 2D and group 3D,and the mean hospital stays were (39.3 ± 5.8) d and (31.5 ± 7.5) d,respectively.There were 4 cases and 12 cases who accepted the second stage operation in group 2D and group 3D respectively.There were 7 cases (4 with grade A,2 with grade B,1 with grade C) and 2 cases(1 with grade A,1 with grade B) with posthepatectomy liver failure and 9 cases (4 with grade Ⅰ,2 with grade Ⅱ,1 with grade Ⅲ,2 with grade Ⅳ) and 3 cases (1 with grade Ⅰ,1 with grade Ⅱ,1 with grade Ⅲ) with postoperative complications in group 2D and group 3D respectively.There were 2 cases and 0 case died after operation in group 2D and group 3D respectively.There were 3 cases and 1 case who were recurrent and 4 cases and 1 case died 6 months after surgery in group 2D and group 3D respectively.Conclusion Three-dimensional visualization technology assisted the formulation of preoperative assessments and surgical planning individually and precisely,which displayed potential application value in HCC treated by ALPPS.

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