术前三维重建技术在大肝癌肝切除手术中的应用

童泽辉 潘浩 王明弘 万云燕 江斌 王健

[摘要] 目的 探討术前三维重建技术在大肝癌肝切除手术中的作用及优势。 方法 收集2017年6月至2019年2月在湖北省十堰市太和医院行肝切除治疗97例肿瘤直径>5 cm的肝癌患者资料。术前行三维重建评估（三维重建组）46 例，未行三维重建（对照组）51例。分析两组患者围术期指标和并发症发生情况。 结果 三维重建组手术时间为（324.81±73.83）min，短于照组的（389.38±95.12）min，差异有统计学意义（P<0.01）。三维重建组入肝血流阻断时间为（27.75±12.85）min，明显短于对照组的（36.80±12.36）min，差异有统计学意义（P<0.05）。三维重建组患者术后住院时间为（12.70±2.94）d，亦短于对照组的（14.76±2.78）d，差异有统计学意义（P<0.01）。三维重建组术中出血量为（393.48±232.76）mL，显著少于对照组的（533.33±224.30）mL，差异有统计学意义（P<0.01），三维重建组术中输血率为8.70%，低于对照组的25.50%，差异有统计学意义（P<0.05）。两组病例术后总体并发症比较无明显差异，围术期无死亡。 结论 术前三维重建技术在辅助大肝癌肝切除方面具有一定优势，可以缩短手术时间、术中入肝血流阻断时间及术后住院时间，减少术中出血量，加快术后康复。

[关键词] 大肝癌;三维重建技术;肝切除术;手术规划

[中图分类号] R657.3          [文献标识码] B          [文章编号] 1673-9701（2021）25-0061-05

Application of preoperative 3D reconstruction technique in hepatectomy for large hepatocellular carcinoma

TONG Zehui1   PAN Hao2   WANG Minghong2   WAN Yunyan2   JIANG Bin2   WANG Jian2

1.Postgraduate Training Base of Jinzhou Medical University， Taihe Hospital of Shiyan City， Hepatobiliary and Pancreatic Diagnosis and Treatment Center， Affiliated Hospital of Hubei University of Medicine， Shiyan   442000， China; 2.Taihe Hospital of Shiyan City in Hubei Province， Hepatobiliary and Pancreatic Diagnosis and Treatment Center， Affiliated Hospital of Hubei University of Medicine， Shiyan   442000， China

[Abstract] Objective To investigate the role and advantages of preoperative three-dimensional （3D） reconstruction technique in hepatectomy for large hepatocellular carcinoma. Methods The data of 97 patients with hepatocellular carcinoma diameter > 5 cm treated by hepatectomy in Taihe Hospital of Shiyan City in Hubei Province from June 2017 to February 2019 was collected. Before operation， 46 patients underwent 3D reconstruction evaluation （the 3D reconstruction group） and 51 patients did not undergo 3D reconstruction （the control group）. The perioperative indicators and the occurrence of complications in the two groups were analyzed. Results The operation duration in the 3D reconstruction group was （324.81±73.83） min， which was shorter than that in the control group（389.38±95.12）min， with statistically significant difference （P<0.01）. The duration of hepatic inflow occlusion in the 3D reconstruction group was （27.75±12.85） min， which was significantly shorter than that in the control group （36.80±12.36）min， with statistically significant difference （P<0.05）. The postoperative hospital stay in the 3D reconstruction group was （12.70±2.94）d， which was also shorter than that in the control group （14.76±2.78）d，with statistically significant difference （P<0.01）. The intraoperative blood loss in the 3D reconstruction group was （393.48±232.76）mL， which was significantly less than that in the control group （533.33±224.30）mL，with statistically significant difference （P<0.01）. The intraoperative blood transfusion rate in the 3D reconstruction group was 8.70%，which was lower than that of  25.50% in the control group， with statistically significant difference （P<0.05）. There was no significant difference in the overall postoperative complications between the two groups of patients，and there was no death in the perioperative period. Conclusion Preoperative 3D reconstruction technique has certain advantages in assisting hepatectomy for large hepatocellular carcinoma，which can shorten the operation duration，duration of intraoperative hepatic inflow occlusion and postoperative hospital stay，reduce intraoperative blood loss and accelerate postoperative recovery.