摘要目的 探讨三维可视化手术规划系统在超声引导下微波消融治疗肝脏大血管瘤的临床价值.方法 回顾性分析2011年1月至2018年8月解放军总医院第一医学中心介入超声科50例肝脏大血管瘤患者临床资料,其中男性12例,女性38例,年龄28.0～60.0(43.0±8.4)岁.依据术前规划不同分为三维组(n=25)和二维组(n=25).比较两组消融治疗前后肝.肾功能变化、完全消融率、肿瘤体积缩小率等指标.结果 消融治疗后二维组丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶及血清肌酐分别为(204.8±76.6)U/L、(206.6±77.4)U/L、(86.2±46.1)U/L、(86.8 ±42.8)mol/L,均高于三维组的(126.7±56.4)U/L、(141.0±60.8)U/L、(57.3±17.6)U/L、(66.6± 16.6)mol/L,差异有统计学意义(均P＜0.05).与二维组比较,三维组消融能量、消融时间、血红蛋白尿发生率均降低,完全消融率升高[(93.7±3.3)％比(97.7±2.4)％],差异有统计学意义(均P＜0.05).结论 三维可视化手术规划系统可提高肝脏大血管瘤的完全消融率,减轻肝肾功能损伤,值得临床推广.

abstracts0bjective To study the use of a three dimensional(3D)visualization operative plan-ning system in Ultrasound-guided percutaneous microwave ablation(US-PMWA)for large hepatic hemangio-mas(LHHs).Methods A total of 50 patients with LHHs from January 201 1 to August 2018 were included in Department of Interventional Ultrasound,the First Medical Center,Chinese PLA General Hospital,inclu-ding 12 males and 38 females(age from 28.0～60,0,mean age was43.0).Fifty patients with LHHs were divided into the 3D and 2D groups(25 cases in each group).The therapeutic efficacy was assessed by con-trast-enhanced imagings on follow-up.Hepatic and renal functions were studied.The complete ablation,tumor volume shrinkage and complication rates were analyzed.Results The levels of alanine aminotrans-ferase,aspartate aminotransferase,alkaline phosphatase,and creatinine after ablation in the 3D group were significantly lower than the 2D group[(126.7±56.4)U/L VS,(204.7±76.5)U/L;(141.0±60.8)U/L vs.(206.6±77.4)U/L;(57.3±17.6)U/L vs.(86.2±46.1)U/L;(66.6±16.6)mmol/L VS.(86.8±42.8)mmol/L,P＜0.05,respectively].Compared with the 2D group,the ablation energy,abla-tion time and proportion of hemoglobinuria in the 3D group were all significantly less,while the complete ablation rate was significantly higher[(93.7±3.3)％VS.(97.7±2.4)％](all P＜0.05).Conclusion The 3D visualization operative planning system provided a scientific,quantifiable,and individualized therapy for LHHs using US-PMWA.