CAJ | 학술논문

目的：探讨原发性肝癌三维可视化诊治平台的构建及临床应用价值。方法本前瞻性研究对象为2012年1月至2014年12月在南方医科大学珠江医院诊治的56例肝癌患者。所有患者均签署知情同意书，符合医学伦理学规定。其中男49例，女7例；平均年龄（47±7）岁。对患者行256层螺旋CT扫描，收集患者平扫期、动脉期、门静脉期和肝静脉期薄层CT数据。将数据导入医学图像三维可视化系统（MI-3DVS），分别对肝脏、肿瘤组织、门静脉系统、肝静脉系统、肝动脉系统及肝脏周围脏器行图像分割和三维可视化分析。然后行个体化肝脏分段、脉管及肝中叶肿瘤分型、个体化体积计算。通过模拟多种仿真手术进行手术规划，选择合理手术方式。对复杂性肝切除患者进行肝脏3D打印。结果56例患者均完成三维可视化模型的构建，可清晰显示肝内各血管系统解剖形态、肿瘤部位及大小，进行肝脏个体化分段，脉管及肝中叶肿瘤分型。经个体化体积计算，患者全肝体积中位数为1215（1025～1856）ml，肝肿瘤体积368（25～653）ml，虚拟切除肝体积478（125～854）ml。56例患者均完成肿瘤根治性切除，实际手术与术前手术规划一致，其中11例复杂性肝切除患者3D打印模型与术中所见完全一致。全部患者手术顺利，无发生围手术期死亡。6例患者术后出现胸腔积液，1例出现肝断面胆漏，经对症治疗后治愈。结论原发性肝癌三维可视化诊治平台可实现术前精确诊断，术中精准操作，提高手术成功率。
목적：탐토원발성간암삼유가시화진치평태적구건급림상응용개치。방법본전첨성연구대상위2012년1월지2014년12월재남방의과대학주강의원진치적56례간암환자。소유환자균첨서지정동의서，부합의학윤리학규정。기중남49례，녀7례；평균년령（47±7）세。대환자행256층라선CT소묘，수집환자평소기、동맥기、문정맥기화간정맥기박층CT수거。장수거도입의학도상삼유가시화계통（MI-3DVS），분별대간장、종류조직、문정맥계통、간정맥계통、간동맥계통급간장주위장기행도상분할화삼유가시화분석。연후행개체화간장분단、맥관급간중협종류분형、개체화체적계산。통과모의다충방진수술진행수술규화，선택합리수술방식。대복잡성간절제환자진행간장3D타인。결과56례환자균완성삼유가시화모형적구건，가청석현시간내각혈관계통해부형태、종류부위급대소，진행간장개체화분단，맥관급간중협종류분형。경개체화체적계산，환자전간체적중위수위1215（1025～1856）ml，간종류체적368（25～653）ml，허의절제간체적478（125～854）ml。56례환자균완성종류근치성절제，실제수술여술전수술규화일치，기중11례복잡성간절제환자3D타인모형여술중소견완전일치。전부환자수술순리，무발생위수술기사망。6례환자술후출현흉강적액，1례출현간단면담루，경대증치료후치유。결론원발성간암삼유가시화진치평태가실현술전정학진단，술중정준조작，제고수술성공솔。
ObjectiveTo investigate the construction and clinical application of three-dimensional visualization platform in diagnosis and treatment of primary liver cancer.MethodsFifty-six patients with liver cancer diagnosed and treated in Zhujiang Hospital of Southern Medical University between January 2012 and December 2014 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 56 patients, 49 were males and 7 were females with the average age of (47±7) years old. The 256-slice spiral CT scan was performed on the patients to collect plain scan data and thin-layer CT data of arterial phase, portal venous phase and hepatic venous phase. The data were imported into the Medical Image Three-dimensional Visualization System (MI-3DVS) to perform image segmentation and three-dimensional visualization analysis of the liver, tumor tissues, portal venous system, hepatic venous system, hepatic arterial system and organs around the liver. The individualized liver segmentation, classification of the vascular and middle lobe tumor was performed and individualized volume was calculated. The surgical planning was formulated through simulating multiple surgery and the rational surgical procedure was selected. For patients undergoing complex hepatectomy, three-dimensional liver model was printed.ResultsThe construction of three-dimensional visualization model of all 56 patients was completed, which could clearly display the anatomical morphology of each vascular system, the location and size of tumor, and perform individual liver segmentation as well as vascular, middle lobe tumor classification. According to individualized volume calculation, the median total liver volume was 1 215 (1 025-1 856) ml, the liver tumor volume was 368 (25-653) ml and the virtual removal liver volume was 478 (125-854) ml. All the 56 patients received radical resection of tumor. The actual operation was in accordant with the preoperative surgical plan. The 3D printing model of 11 patients undergoing complex hepatectomy was exactly the same with that observed during the operation. The operations of all patients were completed successfully and no death was observed during the perioperative period. Six patients developed pleural effusion and one developed bile leakage on the liver cutting surface after operation. These patients were cured after symptomatic treatments.Conclusion Three-dimensional visualization platform for diagnosis and treatment of primary liver cancer can realize the precise preoperative diagnosis and intraoperative manipulation, thus enhances the success rate of surgery.