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目的 探讨计算机辅助手术系统(Higemi)在小儿复杂性肝脏肿瘤精准手术中的诊疗价值及临床意义.方法 对2012年6月至2015年1月因肝门部肿瘤及肝脏巨大肿瘤行肝切除患儿共21例进行分析,使用计算机辅助手术系统(Higemi)对患儿薄层CT图像进行三维重建和手术规划设计,准确判断肿瘤位置及其与周围血管的毗邻关系,明确手术可行性,用以指导手术;分析肿瘤病理分型、手术时间、术中出血量、输血率、并发症等.结果 21例患儿通过计算机辅助手术系统(Higemi)进行三维重建可清晰显示肿瘤的毗邻关系及血管走行.21例肝脏肿瘤中10例位于肝左叶,5例位于肝右叶,3例累及右三叶,3例位于肝中叶.18例行超过三分之一肝脏体积的肝叶切除.术后病理检查示:肝母细胞瘤10例,肝细胞癌3例,错构瘤3例,婴儿型血管内皮瘤3例,畸胎瘤1例,未分化间叶肉瘤1例.手术时间为90～240min,平均130min,术中出血量中位数为60 ml,最少出血量为3 ml,输血率42.9％(9/21),20例患儿成功手术切除肿瘤,康复出院,1例肝脏巨大肿瘤合并严重梗阻性黄疸、严重肝功能不良新生儿病例死于术后肝衰竭加DIC.结论 通过计算机辅助手术系统(Higemi)对CT数据进行三维重建,能清晰显示血管系统走形及与肿瘤的毗邻关系,提高复杂性肝切除手术的准确性和手术安全性.“,”Objective To explore the value of computer-assisted surgical systems (Higemi) for precise surgery in complex liver tumor in children.Methods The clinical data of 21 cases with tumors in middle lobe or giant liver tumors from June 2012 to January 2015 were analyzed.Computer-assisted surgical system (Higemi) was used to three-dimensional reconstruction and surgical planning based upon thin-layer computed tomography (CT) imaging.It could accurately determine the location of tumor and adjacent relationship with surrounding vessels,ascertain surgical feasibility and guide surgery.The tumor pathological type,operative duration,intraoperative blood loss volume,blood transfusion rate and complications were analyzed.Results Three-dimensional reconstruction of computer-assisted surgical system depicted distinctly the adjacent relationship of tumor and vascular course.Among them,10 tumors were located in left lobe,5 in right lobe,3 beyond right lobe and 3 in middle lobe.The volume of removed lobes exceeded one-third of liver in 18 cases.Pathological diagnoses were hepatoblastoma (n =11),hepatocellular carcinoma (n =3),hamartoma (n =3),infantile hemangioendothelioma (n =3),teratoma (n =1) and undifferentiated mesenchymal sarcoma (n =1).The average operative duration was 130 (90-240) min.The median volume of intraoperative blood loss was 60 ml,minimal volume of intraoperative blood loss 3 ml and blood transfusion rate 42.9％ (9/21).Surgical tumor removal was achieved successfully in 20 cases.Only one neonatal case of huge liver tumor died of postoperative liver failure and disseminated intravascular coagulation (DIC) because of severe obstructive jaundice and liver dysfunction.Conclusions The three-dimensional reconstruction of CT data by computer-assisted surgical system (Higemi) can delineate distinctly the vascular system and adjacent relationship of tumor so as to improve the accuracy and safety during complex hepatectomy.