CAJ | 학술논문

目的：研究三维可视化、3D打印、3D腹腔镜（3-3D技术）在肝脏肿瘤外科诊治中的应用价值。方法收集2013年11月~2015年1月22例肝脏肿瘤患者资料，首先进行上腹部薄层CT扫描，收集CT数据，然后利用MI-3DVS软件进行三维可视化、肝脏脉管分型、虚拟肝切除等术前规划。将三维可视化的STL文件打印3D物理模型，进行肝预切除面界定。采用3D腹腔镜进行解剖性肝切除。观察手术时间、术中出血量、实际肝切除体积、术后住院时间。结果肝动脉按Michels分型：Ⅰ型19例，Ⅱ型2例，Ⅷ型1例；门静脉按Cheng分型：Ⅰ型17例，Ⅱ型2例，Ⅲ型2例，Ⅳ型1例。肝静脉根据Nakamura分型：Ⅰ型10例，Ⅱ型7型，Ⅲ型5例。虚拟切除肝体积490±228 ml，残肝体积885±139 ml；残肝体积与功能肝体积之比0.71±0.11。3D打印模型立体显示了肝肿瘤和脉管的空间关系。20例完成腹腔镜肝切除术，2例中转开腹。手术时间186±92 min，术中出血量284±286 ml，实际切除肝体积491±192 ml，术后住院时间为8.6±3.7 d。结论3-3D技术有助于术前安全评估、关键解剖部位的定位、实时导航手术和解剖性肝切除术。
목적：연구삼유가시화、3D타인、3D복강경（3-3D기술）재간장종류외과진치중적응용개치。방법수집2013년11월~2015년1월22례간장종류환자자료，수선진행상복부박층CT소묘，수집CT수거，연후이용MI-3DVS연건진행삼유가시화、간장맥관분형、허의간절제등술전규화。장삼유가시화적STL문건타인3D물리모형，진행간예절제면계정。채용3D복강경진행해부성간절제。관찰수술시간、술중출혈량、실제간절제체적、술후주원시간。결과간동맥안Michels분형：Ⅰ형19례，Ⅱ형2례，Ⅷ형1례；문정맥안Cheng분형：Ⅰ형17례，Ⅱ형2례，Ⅲ형2례，Ⅳ형1례。간정맥근거Nakamura분형：Ⅰ형10례，Ⅱ형7형，Ⅲ형5례。허의절제간체적490±228 ml，잔간체적885±139 ml；잔간체적여공능간체적지비0.71±0.11。3D타인모형입체현시료간종류화맥관적공간관계。20례완성복강경간절제술，2례중전개복。수술시간186±92 min，술중출혈량284±286 ml，실제절제간체적491±192 ml，술후주원시간위8.6±3.7 d。결론3-3D기술유조우술전안전평고、관건해부부위적정위、실시도항수술화해부성간절제술。
Objective To study the value of three-dimensional (3D) visualization, 3D printing and 3D laparoscopy (3-3D techniques) in the diagnosis and surgical treatment of hepatic tumors. Methods From November 2013 to January 2015, 22 patients with hepatic tumors admitted in our department underwent abdominal thin-slice CT scanning. The CT images were imported into Medical Image three Dimensional Visualization System (MI-3DVS) for 3D reconstruction. Standard Template Library (STL) files were exported for 3D printing. The hepatic vascular classification and predicted liver resection were performed with the aid of MI-3DVS system. The 3D models were then printed and virtual liver resections were executed accordingly. Based on these preoperative surgical planning data, we performed anatomical hepatectomy using 3D laparoscopy, and the intraoperative blood loss, volume of virtual and actual liver resection and postoperative hospital stay were recorded. Results According to Michels's classifications, 19 patients had type I, 2 had type II, and 1 had type VIII hepatic arteries;based on Cheng classifications, the portal vein was classified into type I in 17 cases, type II in 2 cases, and type III in 2 cases, and type IV in 1 case;according to Nakamura classifications, the right hemiliver hepatic vein was classified into type I in 10 cases, type II in 7 cases, and type III in 5 cases. In the virtual operations, the mean volume of liver resected was 490±228 ml and the mean remnant liver volume was 885 ± 139 ml, with a remnant to functional liver volume ratio of (71 ± 11)%. The 3D printed models stereoscopically displayed the location of the liver tumors and adjacent liver vascular structure clearly. Laparoscopic hepatectomy was performed successfully in 20 patients guided by the 3-3D techniques, and the other 2 patients required convertion to open hepatectomy. The mean operation time was 186±92 min, the intraoperative blood loss was 284±286 ml, the mean actual liver resection volume was 491±192 ml, and the mean postoperative hospital stay of the patients was 8.6±3.7 days. Conclusions The 3-3D technique can facilitate the evaluation of preoperative risk and critical anatomical structures and navigate the surgical procedure in real time in anatomical hepatectomy for hepatic tumors.