摘要目的:探讨增强现实与混合现实导航技术在三维腹腔镜缩小右半肝切除中的应用效果。方法:回顾性分析2020年9月至2021年6月南方医科大学珠江医院肝胆一科收治的5例肝脏恶性肿瘤患者的病例资料，均为男性，年龄42~74岁。术前使用自主研发的腹部医学图像三维可视化系统进行术前评估，5例患者若行右半肝切除，则余肝体积不足，因而行缩小右半肝切除；术中采用自主研发的三维腹腔镜增强现实与混合现实手术导航系统将术前三维模型、三维腹腔镜场景进行多模图像实时融合与交互，同时通过术中超声辅助吲哚菁绿荧光确定手术路径，完成增强现实与混合现实导航缩小右半肝切除术。分析患者术前评估预切除肝体积与实际切除体积、手术指标和术后并发症发生情况。结果:5例患者均在增强现实与混合现实导航技术指导下完成腹腔镜缩小右半肝切除，无中转开腹情况，手术时间为270~360 min，中位手术时间为300 min，术中均未输血，术后住院时间为7~9 d，术后中位住院时间为8 d。患者围手术期无死亡，术后未发生肝功能衰竭、出血、胆瘘等并发症。结论:对于需行缩小右半肝切除的患者，采用增强现实与混合现实导航技术能安全有效指导手术的实施，可保留更多的功能肝体积，提高手术安全性，减少术后并发症。

abstractsObjective:To investigate the application effect of augmented reality and mixed reality navigation technology in three-dimensional(3D) laparoscopic narrow right hepatectomy(LRH).Methods:A retrospective analysis was performed on the clinical data of 5 patients with hepatic malignancy admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from September 2020 to June 2021,all of whom were males,aged from 42 to 74 years.Preoperative evaluation was performed using the self-developed 3D abdominal medical image visualization system; if all the 5 patients were to receive right hemihepatectomy,the remnant liver volume would be insufficient,so LRH were planned.During the operation,the independently developed 3D laparoscopic augmented reality and mixed reality surgical navigation system was used to perform real-time multi-modal image fusion and interaction between the preoperative 3D model and 3D laparoscopic scene.Meanwhile,intraoperative ultrasound assisted indocyanine green fluorescence was used to determine the surgical path.In this way,the LRH under the guidance of augmented reality and mixed reality navigation was completed.The predicted liver resection volume was evaluated before surgery,actual resected liver volume,surgical indicators and postoperative complications were analyzed.Results:All the 5 patients completed LRH under the guidance of augmented reality and mixed reality navigation technology,with no conversion to laparotomy.The median operative time was 300 minutes(range:270 to 360 minutes),no intraoperative blood transfusion was performed,and the median postoperative hospital stay was 8 days(range:7 to 9 days).There were no perioperative deaths,or postoperative complications such as liver failure,bleeding,or biliary fistula.Conclusion:For patients who need to undergo LRH,the use of augmented and mixed reality navigation technology can safely and effectively guide the implementation of surgery,retain more functional liver volume,improve surgical safety,and reduce postoperative complications.