三维可视化系统在肝门部胆管癌治疗中的应用

Application of three dimensional visualization system in the treatment of hilar cholangiocarcinoma

    摘要
  • 摘要:
    目的 探讨三维可视化系统在肝门部胆管癌治疗中的应用价值。
    方法 回顾性分析2012年1月至9月厦门大学附属成功医院收治的10例肝门部胆管癌患者的临床资料，采用三维可视化系统将CT二维图像转换成三维图像，测量肝脏体积、肿瘤体积、预切除肝脏体积、剩余肝脏体积，并在三维图像上制订预手术方案，模拟肿瘤切除，按照根治理念进行手术，术后比较实际手术方案与预手术方案的区别。术前预切除肝脏体积与术后实际切除肝脏体积的相关性检验采用Pearson等级相关分析。
    结果 本组10例患者均成功进行三维重建，测得平均肝脏体积为(1496±162)ml，肿瘤平均体积为(67±18)ml，预切除肝脏平均体积为(335±241)ml，剩余肝脏平均体积为(1140±197)ml。预切除肝脏体积的平均误差率为6.4%。本组患者按照根治性切除原则进行手术方案制订，左半肝切除4例、右半肝切除2例、局部切除3例、姑息性切除1例。模拟手术方案与实际手术方式符合率为9/10。实际行R0切除7例、R1切除1例、姑息性切除2例，其中1例行限制性门静脉动脉化。根据术中探查证实，术前三维可视化重建对重要血管、胆管及肿瘤的解剖学评估结果与术中所见大致相符。术前三维可视化对肿瘤分型诊断准确率为8/10。实际切除肝脏平均体积为(325±258)ml，术前预切除肝脏体积与术后实际切除肝脏体积呈正相关(r=0.902，P<0.05)。
    结论 三维可视化系统在肝门部胆管癌治疗中具有一定的临床应用价值。

     

    Abstract:
    Objective  To investigate the value of threedimensional visualization system in the treatment of hilar cholangiocarcinoma.
    Methods  The clinical data of 10 patients with hilar cholangiocarcinoma who were admitted to Chenggong Hospital of Xiamen University from January 2012 to September 2012 were retrospectively analyzed. The two-dimensional computed tomography images were converted to threedimensional images with the three-dimensional visualization system, and then the volume of liver and tumor size, volume of liver to be resected, remnant liver volume were measured. Surgical procedure was planned based on the threedimensional images, and the difference between the actual and planned surgical procedures was analyzed. The correlation between actual liver resection volume and predicted liver resection volume was analyzed by calculating the Pearson correlation coefficient.
    Results  The mean liver volume, tumor size, predicted liver resection volume and remnant liver volume of the 10 patients detected by the three-dimensional visualization system were (1496±162)ml, (67±18)ml, (335±241)ml and (1140±197)ml, respectively. The average error rate of predicted liver resection volume was 6.4%. Surgical plan was made in accordance with the principle of curative hepatectomy, including 4 cases of left semihepatectomy, 2 cases of right semihepatectomy, 3 cases of partial liver resection and 1 case of palliative liver resection. The coincidence rate between the planned and actual surgical procedures was 9/10. R0 resection was performed on 7 patients, R1 resection on 1 patient and palliative resection on 2 patients. One patient received restrictive portal vein arterialization. Preoperative evaluation of the anatomy of blood vessels, bile ducts and tumors based on three-dimensional images was confirmed with operative findings. The accuracy of tumor typing by the threedimensional visualization system was 8/10. The actual liver resection volume was (325±258) ml, which was positively correlated with the predicted liver resection volume (r=0.902, P<0.05).
    Conclusion The three -dimensional visualization system is helpful in the treatment of hilar cholangiocarcinoma.

     

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