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目的应用螺旋CT三维成像辅助、指导小儿巨大肝脏肿瘤和复杂部位肝脏肿瘤的诊断及手术治疗。方法对近5年来肝脏巨大和位于肝门的复杂部位肝脏肿瘤18例进行分析、总结。10例使用螺旋CT三维成像检查,以辅助指导手术的具体操作。结果18例中肝右叶切除7例,右三叶切除3例,肝左叶3例,多发性1例,左三叶1例,3例为肝门部肝中叶或扩大肝中叶切除。其中肝母细胞瘤9例、畸胎瘤1例、肝细胞癌2例、肝腺瘤2例、错构瘤4例。10例三维成像者均获得清晰的肿瘤瘤体和与血管比邻关系的图像。16例行超过肝脏体积三分之一的肝叶切除,最大者切除瘤肝达4800g。全组成功手术切除,均康复出院。结论通过动态三维立体的画面,特别是可以旋转的动态影像能清楚显示血管的走行、位置。对手术方案的选择、制定、肝脏切线的选择都提供很大的帮助。
Objective To apply helical CT three-dimensional imaging to guide the diagnosis and surgical treatment of pediatric liver tumors of large and complex parts. Methods In the past 5 years, there were 18 cases of liver tumors with huge liver and complex parts located in the hilar portal. 10 cases using spiral CT three-dimensional imaging examination to assist in guiding the operation of the specific operation. Results In 18 cases, 7 cases were resected in the right lobe of the liver, 3 cases were in the right three-lobectomy, 3 cases in the left lobe, 1 case were multiple, 1 case was in the left clover. Including hepatoblastoma in 9 cases, 1 teratoma, hepatocellular carcinoma in 2 cases, 2 cases of hepatic adenoma, hamartoma in 4 cases. Ten cases of three-dimensional imaging were obtained clear tumor tumor and the image of the relationship with the blood vessels. 16 cases of liver volume more than one-third of the liver resection, the largest removal of tumor liver up to 4800g. Successful surgical resection of the whole group were recovered and discharged. Conclusion Through the dynamic three-dimensional images, in particular, can rotate the dynamic images can clearly show the blood vessels walk, location. The choice of surgical options, development, selection of liver tangents are of great help.