CAJ | 학술논문

目的探讨应用肝脏三维重建模型进行虚拟肝脏手术,对实际手术方案制定及术中策略的影响.方法收集我院2010年1月至12月22例肝大部分切除术患者临床资料,其中男17例,女5例.所有患者术前均行64-MSCT三期薄层扫描.将获得的影像数据导入Myrian(R) XP-Liver医学影像分析系统(Intrasense(R),France),分别由一名外科医生和一名影像科医生将扫描图像三维重建来进行虚拟肝脏手术切除.结果应用Myrian(R) XP-Liver医学影像分析系统获得的肝脏三维重建模型显示的肝脏形态、肿瘤大小、位置及其与周围血管的空间毗邻关系清晰,并且可从多个角度进行观察分析.22例患者都施行了肝脏大部分切除术,其中20例完整切除肿瘤,达到R0切除,2例为R1切除.2例R1切除中1例原发性肝癌切缘最小距离肿瘤＜4 mm,切缘阳性;另1例肝门部胆管癌,术后病理镜下证实胆管断端阳性.无手术死亡和住院期间死亡.本组有6例患者预后风险分析认为术后肝功能障碍发生危险性增加,于是调整切除范围,制定合理的手术方案,取得良好的手术效果.结论应用Myrian(R) XP-Liver医学影像分析系统进行肝脏三维重建及虚拟肝脏切除手术,可以更为精确、安全地施行复杂的肝脏大部分切除术,最大限度减少术后肝功能障碍的发生,为制定合理的手术方案和采取正确的术中策略提供重要的术前参考.
목적 탐토응용간장삼유중건모형진행허의간장수술,대실제수술방안제정급술중책략적영향.방법 수집아원2010년1월지12월22례간대부분절제술환자림상자료,기중남17례,녀5례.소유환자술전균행64-MSCT삼기박층소묘.장획득적영상수거도입Myrian(R) XP-Liver의학영상분석계통(Intrasense(R),France),분별유일명외과의생화일명영상과의생장소묘도상삼유중건래진행허의간장수술절제.결과 응용Myrian(R) XP-Liver의학영상분석계통획득적간장삼유중건모형현시적간장형태、종류대소、위치급기여주위혈관적공간비린관계청석,병차가종다개각도진행관찰분석.22례환자도시행료간장대부분절제술,기중20례완정절제종류,체도R0절제,2례위R1절제.2례R1절제중1례원발성간암절연최소거리종류＜4 mm,절연양성;령1례간문부담관암,술후병리경하증실담관단단양성.무수술사망화주원기간사망.본조유6례환자예후풍험분석인위술후간공능장애발생위험성증가,우시조정절제범위,제정합리적수술방안,취득량호적수술효과.결론 응용Myrian(R) XP-Liver의학영상분석계통진행간장삼유중건급허의간장절제수술,가이경위정학、안전지시행복잡적간장대부분절제술,최대한도감소술후간공능장애적발생,위제정합리적수술방안화채취정학적술중책략제공중요적술전삼고.
Objectives To evaluate the impact of virtual hepatectomy and computer-assisted risk analysis on surgical planning and intraoperative strategy for major hepatectomy.Methods Twentytwo consecutive patients (17 males and 5 females) were admitted to the hospital from January to December in 2010 for complicated major hepatectomy.CT scanning was performed with 64-MSCT.All the data of imaging were transferred to the Myrian(R) XP-Liver system (IntrasenseR,France).The following steps were undertaken by a radiologist and a surgeon majoring in liver surgery: step 1,image analysis and 3-D reconstruction; step 2,virtual resection and liver volumetry; step 3,computer-assisted risk analysis for hepatic dysfunction,followed by adjustment of the operative planning.Results The three-dimensional reconstruction models of the liver by the Myrian(R) XP-Liver system were visualized.The ideal simulation effect was achieved comparing the virtual imaging with the actual operation.Of the 22 patients who underwent complicated major hepatectomy,complete tumor removal (R0 resection) was achieved in 20 patients.There were 2 patients who received a R1 resection as microscopic tumor cells were found at the cutting margin of the right portal vein and bile duct.No patient died during the hospital stay.After computer-assisted risk analysis,the operative planning and surgical strategies were changed in 6 patients.Conclusions The application of the hepatic three-dimensional reconstruction and virtual hepatectomy using the Myrian(R) XP-Liver system provided important preoperative data for good preoperative planning and intraoperative strategy in complex hepatectomy.