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中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 381 -384. doi: 10.3877/cma.j.issn.1674-3946.2020.04.018

所属专题: 文献

论著

三维重建技术辅助的肝切除术对肝癌患者的价值分析
成超1, 彭彬1, 贾守洪1,()   
  1. 1. 638000 四川广安,四川大学华西广安医院(广安市人民医院)
  • 收稿日期:2019-10-31 出版日期:2020-08-26
  • 通信作者: 贾守洪

Clinical Value of three-dimensional reconstruction assisted hepatectomy for patients with liver cancer

Chao Cheng1, Bin Peng1, Shouhong Jia1,()   

  1. 1. Sichuan University Huaxi Guangan Hospital (Guang’an People’s Hospital), Sichuan Guangan 638000
  • Received:2019-10-31 Published:2020-08-26
  • Corresponding author: Shouhong Jia
  • About author:
    Corresponding author: Jia Shouhong, Email:
  • Supported by:
    General Project of Natural Science basic Research of Sichuan Science and Technology Department(2018JM7256)
引用本文:

成超, 彭彬, 贾守洪. 三维重建技术辅助的肝切除术对肝癌患者的价值分析[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(04): 381-384.

Chao Cheng, Bin Peng, Shouhong Jia. Clinical Value of three-dimensional reconstruction assisted hepatectomy for patients with liver cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(04): 381-384.

目的

探讨基于三维重建技术在肝切除术中的应用价值。

方法

回顾性分析2017年3月至2019年7月46例行腹腔镜手术难度评分≥8的肝切除术治疗肝癌患者资料,依据术前评估的方法不同将其分为CT增强组(n=22)和三维重建组(n=24)。选用SPSS 22.00统计软件进行数据分析。病灶评估、围术期和肝功能指标等计量资料(±s)表示,采用独立t检验;血管侵犯判断的准确率、并发症发生情况等采用χ2Fisher检验。P<0.05差异有统计学意义。

结果

46例肝癌患者均成功完成腹腔镜肝切除术,无术中死亡及中转开腹。三维重建组24例患者中有3例更改手术方案。CT增强组对血管侵犯判断符合率57.1%(8/13),三维重建组84.6%(10/13),差异无统计学意义(P>0.05)。三维重建组实际切除肝体积与剩余肝体积与CT增强组比较差异有统计学意义(P<0.05)。三维重建组术中出血量明显少于CT增强组(P<0.05)。三维重建组术后肝功能指标较术前明显降低,且明显小于CT增强组(P<0.05)。

结论

三维重建技术辅助的肝切除术对手术难度大的肝癌患者有较高的应用价值。

Objective

To investigate the clinical value of the three-dimensional (3D) reconstruction assisted hepatectomy for patients with liver cancer.

Methods

Retrospective analysis were performed from March 2017 to July 2019, in 46 patients who received laparoscopic hepatectomy with Surgical Difficulty Score of ≥8.46 patients were divided into enhanced CT group (n=22) and 3D reconstruction group (n=24) according to the different preoperative evaluation methods. SPSS 22.00 statistical software were used for data analysis. Measurement data such as lesion assessment, perioperative indexes and liver function indicators were expressed as (±s) and were examined by using independent t test. The accuracy of vascular invasion and complications were examined by using χ2 or Fisher test. A P value <0.05 was considered as statistically significant difference.

Results

All of 46 patients received successful laparoscopic hepatectomy without intraoperative death or conversion to laparotomy. There were 3 cases of surgical plan change among 24 patients in the 3D reconstruction group. The coincidence rate of vascular invasion was 57.1% (8/13) in the enhanced CT group, while 84.6% (10/13) in the 3D reconstruction group, without significant difference (P>0.05). The actual volume of resected liver and residual liver in the 3D reconstruction group were significantly different from those in the enhanced CT group respectively (P<0.05). The intraoperative blood loss in the 3D reconstruction group was significantly less than that in the enhanced CT group (P<0.05). The indexes of postoperative liver function in the 3D reconstruction group were significantly decreased, however with a lower drop than those in the enhanced CT group, with significant differences (P<0.05).

Conclusion

Three-dimensional reconstruction assisted hepatectomy has clinical value in treating patient with difficult liver cancers.

表1 46例肝癌患者术前评估方法不同两组患者基本资料比较[(±s),例]
图1 肝癌患者术前评估肝门部胆管占位三维重建图
表2 46例肝癌患者术前评估方法不同两组患者一般情况比较(例)
表3 46例肝癌患者术前评估方法不同两组患者病灶评估指标比较[ (±s), cm3]
表4 46例肝癌患者术前评估方法不同两组患者肝功能指标比较(±s)
表5 46例肝癌患者术前评估方法不同两组患者围术期指标及术后并发症比较(±s)
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