CAJ | 학술논문

目的探讨医学图像三维可视化系统(MI-3DVS)在精准肝切除中的指导作用.方法 2008年6月至2010年9月南方医科大学珠江医院利用自行研发的MI-3DVS在术前对45例肝癌患者肝脏的CT薄层图像数据进行三维重建.根据肝内门静脉和肝静脉走行划分肝段,确定肿瘤所在位置,测算切除的功能性肝脏体积并计算剩余肝脏体积百分比.术前评估可切除性,制订个体化的手术方案,然后进行仿真手术演练,指导临床手术.结果 45例肝癌患者根据肝内肝静脉和门静脉的走行分布分为7种类型:常见型21例,与Couinaud分段相同;未分型6例;肝右叶未分型11例;肝左叶未分型4例;肝右静脉型1例;肝中静脉双支型1例;右后下静脉型1例.39例患者行开腹肝癌切除术,平均剩余肝脏体积百分比为74%±17%,术后病理检查均为肝细胞癌;6例患者行TACE治疗.所有患者术后未发生急性肝功能衰竭、出血、胆汁漏等严重并发症.出院后随访6个月,患者无瘤或带瘤生存.结论用MI-3DVS进行术前评估和指导临床手术,符合肝脏解剖与生理特点,对精准肝切除有重要的指导作用.
목적 탐토의학도상삼유가시화계통(MI-3DVS)재정준간절제중적지도작용.방법 2008년6월지2010년9월남방의과대학주강의원이용자행연발적MI-3DVS재술전대45례간암환자간장적CT박층도상수거진행삼유중건.근거간내문정맥화간정맥주행화분간단,학정종류소재위치,측산절제적공능성간장체적병계산잉여간장체적백분비.술전평고가절제성,제정개체화적수술방안,연후진행방진수술연련,지도림상수술.결과 45례간암환자근거간내간정맥화문정맥적주행분포분위7충류형:상견형21례,여Couinaud분단상동;미분형6례;간우협미분형11례;간좌협미분형4례;간우정맥형1례;간중정맥쌍지형1례;우후하정맥형1례.39례환자행개복간암절제술,평균잉여간장체적백분비위74%±17%,술후병리검사균위간세포암;6례환자행TACE치료.소유환자술후미발생급성간공능쇠갈、출혈、담즙루등엄중병발증.출원후수방6개월,환자무류혹대류생존.결론 용MI-3DVS진행술전평고화지도림상수술,부합간장해부여생리특점,대정준간절제유중요적지도작용.
Objective To investigate the guiding significance of medical image three-dimensional visualization system (MI-3DVS) in precise hepatectomy. Methods The clinical data of 45 patients with hepatic neoplasms who were admitted to the Zhujiang Hospital from June 2008 to September 2010 were prospectively analyzed. The preoperative image data of the liver were three-dimensionally reconstructed by MI-3DVS. According to the distribution of the intrahepatic portal veins and hepatic veins, the liver was divided into different sections,and then tumors can be located within these hepatic segments. The volume percentage of residual liver and volume of liver resected were detected. Evaluation of surgical resectability and surgery simulation were done before operation. Results According to the distribution of the intrahepatic portal veins and hepatic veins, all patients were divided into seven types: 21 patients were with normal type which was the same as Couinaud type, six with nondivided type, 11 with non-divided right liver type, four with non-divided left liver type, one with right hepatic vein type, one with double middle hepatic vein type and one with right posterior vein type. Thirty-nine patients received open hepatectomy, and the volume percentage of the residual liver was 74% ± 17%. Postoperative pathological examination confirmed that all the 39 patients were with hepatocellular carcinoma. Six patients received transcatheter arterial chemoembolization. No severe complications such as acute hepatic failure, bleeding, bile leakage were detected. All patients were followed up for six months, and they survived with or without tumor. Conclusion MI-3DVS has guiding significance in preoperative assessment and perioperative guidance for precise hepatectomy.