CAJ | 학술논문

目的：探讨三维可视化系统（MI-3DVS软件系统）在肝门部胆管癌术前评估和手术规划中的应用价值。方法本前瞻性研究对象为2009年6月至2013年12月在南方医科大学珠江医院应用MI-3DVS软件进行术前评估的13例肝门部胆管癌患者。所有患者均签署知情同意书，符合医学伦理学规定。其中男8例，女5例；年龄34～81岁，中位年龄55岁。采用64排或256排螺旋CT进行肝、胆、胰、脾和腹腔血管等增强扫描，采集患者平扫期、动脉期、门静脉期和静脉期的4套医学数字成像和数据。将患者各期数据导入MI-3DVS，进行图像分割和三维重建。对重建图像进行可视化处理后，观察肿瘤与肝内胆管、肝动脉、门静脉系统和肝静脉系统的三维立体关系，并进行Bismuth-Corlette分型，模拟手术并制定手术方案。结果13例患者的重建模型均准确显示肝脏形态及其管道系统的解剖标志，肝门部胆管癌、肝内各种管道系统等结构形态逼真，立体感强，各分支走向清晰。根据三维重建结果对肿瘤进行Bismuth-Corlette分型，Ⅲa型1例，Ⅲb型7例，Ⅳ型5例。术前三维重建对肿瘤分型诊断准确率100%（13/13）。模拟手术与实际手术方式符合率为85%（11/13）。患者的手术时间为630（300～720）min，术中出血量420（110～1800）ml；手术并发症发生率23%（3/13），其中切口感染2例，胆漏1例，均经保守治疗痊愈。结论三维可视化系统能准确、直观、动态地显示肝门部胆管癌及其三维毗邻关系，可对患者进行准确的术前评估和手术规划。
목적：탐토삼유가시화계통（MI-3DVS연건계통）재간문부담관암술전평고화수술규화중적응용개치。방법본전첨성연구대상위2009년6월지2013년12월재남방의과대학주강의원응용MI-3DVS연건진행술전평고적13례간문부담관암환자。소유환자균첨서지정동의서，부합의학윤리학규정。기중남8례，녀5례；년령34～81세，중위년령55세。채용64배혹256배라선CT진행간、담、이、비화복강혈관등증강소묘，채집환자평소기、동맥기、문정맥기화정맥기적4투의학수자성상화수거。장환자각기수거도입MI-3DVS，진행도상분할화삼유중건。대중건도상진행가시화처리후，관찰종류여간내담관、간동맥、문정맥계통화간정맥계통적삼유입체관계，병진행Bismuth-Corlette분형，모의수술병제정수술방안。결과13례환자적중건모형균준학현시간장형태급기관도계통적해부표지，간문부담관암、간내각충관도계통등결구형태핍진，입체감강，각분지주향청석。근거삼유중건결과대종류진행Bismuth-Corlette분형，Ⅲa형1례，Ⅲb형7례，Ⅳ형5례。술전삼유중건대종류분형진단준학솔100%（13/13）。모의수술여실제수술방식부합솔위85%（11/13）。환자적수술시간위630（300～720）min，술중출혈량420（110～1800）ml；수술병발증발생솔23%（3/13），기중절구감염2례，담루1례，균경보수치료전유。결론삼유가시화계통능준학、직관、동태지현시간문부담관암급기삼유비린관계，가대환자진행준학적술전평고화수술규화。
ObjectiveTo investigate the application value of three-dimensional visualization system (MI-3DVS software system) in the preoperative evaluation and surgical planning for hilar cholangiocarcinoma.MethodsThirteen patients with hilar cholangiocarcinoma undergoing preoperative evaluation with MI-3DVS software in Zhujiang Hospital, Southern Medical University between June 2009 and December 2013 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 13 patients, 8 were males and 5 werefemales with the age ranging from 34 to 81 years old and the median of 55 years old. Enhanced scan of liver, gallbladder, pancreas, spleen and blood vessels in abdominal cavity was performed on the patients with 64-slice or 256-slice spiral CT. Four sets of medical digital imaging and data of plain scan phase, arterial phase, portal venous phase and venous phase were collected. The data of each phase were introduced into MI-3DVS to perform image segmentation and three-dimensional reconstruction. The three-dimensional relationship between tumor and intrahepatic bile duct, hepatic artery, portal venous system and hepatic venous system was observed after the reconstructed images were visualized and Bismuth-Corlette classiifcation was determined for the tumors. Moreover, surgery was simulated and surgical planning was formulated.Results The reconstructed models of 13 patients all exactly displayed the shape of liver and anatomic landmark of duct system. The structure and shape of hilar cholangiocarcinoma and various intrahepatic duct systems were realistic and stereoscopic and the direction of various branches was clear. Bismuth-Corlette classification of tumors was determined according to the results of three-dimensional reconstruction. One case was typeⅢa, 7 were typeⅢb and 5 were typeⅣ. The accuracy rate of tumor classification was 100%(13/13) by preoperative three-dimensional reconstruction. The coincidence rate of simulated surgery and actual operative procedure was 85% (11/13). The median operation time was 630 (300~720) min and the intraoperative blood loss was 410 (110~1 800) ml. The incidence of surgical complications was 23% (3/13). Two patients developed incision infection and 1 developed bile leakage. All were cured with conservative treatment. ConclusionThree-dimensional visualization system may accurately, directly and dynamically display the hilar cholangiocarcinoma and its three-dimensional adjacent relation, which may be used to perform accurate preoperative evaluation and surgical planning for patients.