CAJ | 학술논문

目的：探讨数字化三维重建技术在肝泡型包虫病（HAE）肝移植中的应用价值。方法回顾性研究2012年4月至2014年12月在新疆医科大学第一附属医院接受肝移植治疗的21例终末期HAE患者及6例活体肝移植供者临床资料。患者中男13例，女8例；平均年龄（43±13）岁。供者中男4例，女2例，年龄（40±9）岁。行离体肝切除自体肝移植15例，活体肝移植6例。所有患者及6例活体肝移植供者均签署知情同意书，符合医学伦理学规定。患者及供者术前均行CT平扫、3期（动脉期、门静脉期和延迟期）增强扫描及CT血管造影（CTA），根据肝脏二维图像测量全肝体积和供肝体积。采用数字化肝脏三维重建软件进行三维模型重建，再次测量全肝体积和供肝体积，设计肝脏切除平面并进行个体化虚拟手术。于肝移植术中对实际全肝体积和供肝体积进行测量后计算术前评估肝体积误差率。肝体积数据的比较采用t检验,供肝体积误差率的比较采用χ2检验。结果三维重建模型可清楚显示肝内解剖关系，且与术中所见一致。15例离体肝切除自体肝移植患者及6例活体肝移植供者数字化三维重建技术计算的供肝体积为（766±197）ml，明显小于二维测量法的（833±243）ml（t=-3.674，P<0.05）。与术中测量的实际供肝体积（955±194）ml相比，数字化三维重建技术计算的供肝体积的平均误差率为（6±1）%，明显小于二维测量法的（13±2）%（t=-14.346，P<0.05）。三维重建测量的供肝体积与术中实际供肝体积呈正相关（r=0.967，P<0.05）。所有患者均顺利完成手术，1例术后12 d死于急性肾衰竭，其余未出现肝衰竭或出血等严重并发症。术后复查CT三维重建见所有移植肝增生良好，肝内各脉管吻合口通畅。结论肝移植治疗终末期HAE术前评估以及手术规划过程中应用数字化三维重建技术，可提高手术的精准性和成功率，取得良好的疗效。目的：探討數字化三維重建技術在肝泡型包蟲病（HAE）肝移植中的應用價值。方法迴顧性研究2012年4月至2014年12月在新疆醫科大學第一附屬醫院接受肝移植治療的21例終末期HAE患者及6例活體肝移植供者臨床資料。患者中男13例，女8例；平均年齡（43±13）歲。供者中男4例，女2例，年齡（40±9）歲。行離體肝切除自體肝移植15例，活體肝移植6例。所有患者及6例活體肝移植供者均籤署知情同意書，符閤醫學倫理學規定。患者及供者術前均行CT平掃、3期（動脈期、門靜脈期和延遲期）增彊掃描及CT血管造影（CTA），根據肝髒二維圖像測量全肝體積和供肝體積。採用數字化肝髒三維重建軟件進行三維模型重建，再次測量全肝體積和供肝體積，設計肝髒切除平麵併進行箇體化虛擬手術。于肝移植術中對實際全肝體積和供肝體積進行測量後計算術前評估肝體積誤差率。肝體積數據的比較採用t檢驗,供肝體積誤差率的比較採用χ2檢驗。結果三維重建模型可清楚顯示肝內解剖關繫，且與術中所見一緻。15例離體肝切除自體肝移植患者及6例活體肝移植供者數字化三維重建技術計算的供肝體積為（766±197）ml，明顯小于二維測量法的（833±243）ml（t=-3.674，P<0.05）。與術中測量的實際供肝體積（955±194）ml相比，數字化三維重建技術計算的供肝體積的平均誤差率為（6±1）%，明顯小于二維測量法的（13±2）%（t=-14.346，P<0.05）。三維重建測量的供肝體積與術中實際供肝體積呈正相關（r=0.967，P<0.05）。所有患者均順利完成手術，1例術後12 d死于急性腎衰竭，其餘未齣現肝衰竭或齣血等嚴重併髮癥。術後複查CT三維重建見所有移植肝增生良好，肝內各脈管吻閤口通暢。結論肝移植治療終末期HAE術前評估以及手術規劃過程中應用數字化三維重建技術，可提高手術的精準性和成功率，取得良好的療效。
목적：탐토수자화삼유중건기술재간포형포충병（HAE）간이식중적응용개치。방법회고성연구2012년4월지2014년12월재신강의과대학제일부속의원접수간이식치료적21례종말기HAE환자급6례활체간이식공자림상자료。환자중남13례，녀8례；평균년령（43±13）세。공자중남4례，녀2례，년령（40±9）세。행리체간절제자체간이식15례，활체간이식6례。소유환자급6례활체간이식공자균첨서지정동의서，부합의학윤리학규정。환자급공자술전균행CT평소、3기（동맥기、문정맥기화연지기）증강소묘급CT혈관조영（CTA），근거간장이유도상측량전간체적화공간체적。채용수자화간장삼유중건연건진행삼유모형중건，재차측량전간체적화공간체적，설계간장절제평면병진행개체화허의수술。우간이식술중대실제전간체적화공간체적진행측량후계산술전평고간체적오차솔。간체적수거적비교채용t검험,공간체적오차솔적비교채용χ2검험。결과삼유중건모형가청초현시간내해부관계，차여술중소견일치。15례리체간절제자체간이식환자급6례활체간이식공자수자화삼유중건기술계산적공간체적위（766±197）ml，명현소우이유측량법적（833±243）ml（t=-3.674，P<0.05）。여술중측량적실제공간체적（955±194）ml상비，수자화삼유중건기술계산적공간체적적평균오차솔위（6±1）%，명현소우이유측량법적（13±2）%（t=-14.346，P<0.05）。삼유중건측량적공간체적여술중실제공간체적정정상관（r=0.967，P<0.05）。소유환자균순리완성수술，1례술후12 d사우급성신쇠갈，기여미출현간쇠갈혹출혈등엄중병발증。술후복사CT삼유중건견소유이식간증생량호，간내각맥관문합구통창。결론간이식치료종말기HAE술전평고이급수술규화과정중응용수자화삼유중건기술，가제고수술적정준성화성공솔，취득량호적료효。
ObjectiveTo investigate the application value of digital three-dimensional reconstruction in liver transplantation for hepatic alveolar echinocoecosis (HAE).MethodsClinical data of 21 patients with end-stage HAE undergoing liver transplantation (LT) and 6 living donors in the First Affiliated Hospital of Xinjiang Medical University between April 2012 and December 2014 were retrospectively studied. Among the 21 patients, 13 were males and 8 were females with the average age of (43±13) years old. Among the 6 donors, 4 were males and 2 were females with the average age of (40±9) years old. Fifteen cases underwent extracorporeal hepatectomy and autotransplantation and 6 cases underwent living donor LT. The informed consents of all patients and 6 living donors were obtained and the local ethical committee approval had been received. All patients and donors received computer tomography (CT) plain scan, 3-phase (arterial phase, portal venous phase and delayed phase) enhancement scan and computed tomography angiography (CTA). The total liver volume and the liver graft volume were measured according to the two-dimensional liver image. The digital three-dimensional liver reconstruction software was used to perform three-dimensional model reconstruction. The total liver volume and the liver graft volume were measured a second time. The liver section was designed and the individualized virtual surgery was performed. The actual total liver volume and the liver graft volume were measured during LT to assess the error rate of liver volume predicted before operation. The comparison of liver volume data was conducted usingt test and the comparison of the error rate of liver graft volume was conducted using Chi-square test.Results The intrahepatic anatomical relationship was clearly displayed by the three-dimensional model, which was in accordance with that observed during operation. The liver graft volume of 15 patients undergoing extracorporeal hepatectomy and autotransplantation and 6 patients undergoing living donor LT calculated by the digital three-dimensional reconstruction technology was (766±197) ml, which was signiifcantly smaller than (833±243) ml calculated by the two-dimensional measurement (t=-3.674,P<0.05). Compared with the actual liver graft volume of (955±194) ml measured during operation, the average error rate of the liver graft volume calculated by the three-dimensional reconstruction technology was (6±1) %, which was signiifcantly smaller than (13±2) % of that calculated by two-dimensional measurement (t=-14.346,P<0.05). The liver graft volume measured by the three-dimensional measurement was positively correlated with the actual liver graft volume measured during operation (r=0.967,P<0.05). All the operations were completed successfully. One patient died of acute renal failure 12 d after LT. No case was observed developing liver failure or hemorrhage or other severe complications. The growth of the liver graft was good and the anastomotic stoma of intrahepatic vessels was clear by CT reexamination and three-dimensional reconstruction after operation. ConclusionThe application of three-dimensional reconstruction technology in preoperative assessment and operation planning of LT for end-stage HAE can improve the precision and success rate and achieve good curative effect.