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目的探讨3D可视化技术在婴幼儿复杂肝肿瘤精准肝切除中的应用价值。方法回顾性分析2012年6月至2015年1月在青岛大学附属医院采用3D可视化技术行复杂肝肿瘤精准肝切除术的16例婴幼儿临床资料。其中男10例,女6例;年龄22 d~3岁,中位年龄1岁2个月。12例瘤体巨大累及相应的肝门部;4例为原发于肝门部位的肿瘤。所有患儿家属均签署知情同意书,符合医学伦理学规定。采用64排螺旋CT对患儿进行检查,将扫描数据导入计算机辅助手术系统(Higemi)中进行三维重建,并计算剩余肝脏与标准化全肝体积比值(RSLVR)。根据三维重建图像,术前进行精准肝切除术规划。结果经Higemi三维重建后可清晰显示肝内脉管系统,包括门静脉、肝动脉及肝静脉的走行、分支和空间构象,可任意角度观察病灶与其周围脉管结构的空间解剖关系,准确地对病变进行定位和评估。术前三维重建结果与术中实际情况一致。16例患儿均按术前设计方案顺利进行了肝切除术。RSLVR中位数为44.7%(21.1%~78.4%),手术时间145(90~230)min,术中出血量60(3~100)ml,输血率38%(6/16)。1例肝右叶巨大肿瘤患儿术后发生弥散性血管内凝血,积极治疗无效后死亡,余15例患儿无发生术后并发症,顺利出院。结论对于婴幼儿复杂肝肿瘤,3D可视化技术能对肿瘤进行准确的术前评估,并辅助设计最优手术方案,使婴幼儿复杂肝肿瘤肝切除更加精准、安全、有效。
Objective To explore the value of 3D visualization in the precise hepatectomy of complex hepatic tumors in infants and young children. Methods The clinical data of 16 infants and toddlers with complicated liver tumor underwent hepatectomy using 3D visualization technique at the Affiliated Hospital of Qingdao University from June 2012 to January 2015 were retrospectively analyzed. Including 10 males and 6 females; aged 22 d ~ 3 years, the median age of 1 year and 2 months. 12 cases of tumor involving the corresponding huge hilar and 4 cases of primary tumors in the hilar. All children and relatives signed informed consent, in line with medical ethics rules. The patients were examined by 64-slice spiral CT. The scanned data were imported into the Higemi for three-dimensional reconstruction and the remaining liver and normalized whole liver volume ratio (RSLVR) were calculated. According to three-dimensional reconstruction of images, preoperative precision hepatectomy planning. Results Higemi three-dimensional reconstruction can clearly show the intrahepatic vasculature, including the portal vein, hepatic artery and hepatic veins walking, branching and spatial conformation, can be any angle to observe the spatial anatomy of the lesion and its surrounding vascular structures accurately on the lesion Positioning and evaluation. Preoperative 3D reconstruction results consistent with the actual situation in surgery. All 16 patients underwent hepatectomy according to preoperative design plan. The median RSLVR was 44.7% (21.1% -78.4%) and the operation time was 145 (90-230) min. The intraoperative blood loss was 60 (3-100) ml and the blood transfusion rate was 38% (6/16). One case of giant tumor with right lobe of the liver had disseminated intravascular coagulation after operation, and died after active treatment was ineffective. No other postoperative complications occurred in the remaining 15 cases and the patients were discharged smoothly. Conclusion For the complex liver tumor in infants and young children, 3D visualization technology can accurately assess the tumor and assist in the design of the optimal surgical plan, which can make the hepatectomy of the complex liver tumor in infants and children more accurate, safe and effective.