術前三維重建技術在大肝癌肝切除手術中的應用

童澤輝 潘浩 王明弘 萬云燕 江斌 王健

[摘要] 目的 探討術前三維重建技術在大肝癌肝切除手術中的作用及優勢。 方法 收集2017年6月至2019年2月在湖北省十堰市太和醫院行肝切除治療97例腫瘤直徑>5 cm的肝癌患者資料。術前行三維重建評估（三維重建組）46 例，未行三維重建（對照組）51例。分析兩組患者圍術期指標和并發癥發生情況。 結果 三維重建組手術時間為（324.81±73.83）min，短于照組的（389.38±95.12）min，差異有統計學意義（P<0.01）。三維重建組入肝血流阻斷時間為（27.75±12.85）min，明顯短于對照組的（36.80±12.36）min，差異有統計學意義（P<0.05）。三維重建組患者術后住院時間為（12.70±2.94）d，亦短于對照組的（14.76±2.78）d，差異有統計學意義（P<0.01）。三維重建組術中出血量為（393.48±232.76）mL，顯著少于對照組的（533.33±224.30）mL，差異有統計學意義（P<0.01），三維重建組術中輸血率為8.70%，低于對照組的25.50%，差異有統計學意義（P<0.05）。兩組病例術后總體并發癥比較無明顯差異，圍術期無死亡。 結論 術前三維重建技術在輔助大肝癌肝切除方面具有一定優勢，可以縮短手術時間、術中入肝血流阻斷時間及術后住院時間，減少術中出血量，加快術后康復。

[關鍵詞] 大肝癌;三維重建技術;肝切除術;手術規劃

[中圖分類號] R657.3? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 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.