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目的:探讨术前双源CT下肝血管造影三维重建成像联合术中区域血流阻断美蓝持久染色在精准肝切除术中的应用价值。方法:37例行肝癌患者术前均行双源CT下肝血管造影成像三维重建,术中先解剖第一肝门,显露预切肝叶/段Glisson鞘各管,从预切肝叶/段门静脉属支(门静脉有癌栓者从胆管)注入美蓝染色,阻断拟切除肝血流,按染色的界限行肝叶/段切除。将该37例患者(观察组)与同期32例行传统肝切除手术肝癌患者(对照组)作比较。结果:观察组37例行精准肝切除患者术前肝血管造影成像和术中肝脏染色相一致。与对照组比较,观察组手术时间延长,切肝出血量减少,肝功能指标变化小、恢复快,并发症发生率降低,住院时间缩短(均P<0.05)。结论:双源CT下肝血管造影成像三维重建联合区域血流阻断美蓝持久染色应用于精准肝切除手术,能减少出血,避免误伤保留肝脏的Glisson管道,减少肝功能损害和手术并发症。
Objective: To explore the value of preoperative double-source CT angiography combined with three-dimensional reconstruction of intraoperative blood flow blocking methylene blue for long-term precision hepatectomy. Methods: Thirty-seven patients with hepatocellular carcinoma underwent preoperative double-source CT angiography underwent three-dimensional reconstruction. The first hepatic portal was dissected and the Glisson sheath of pre-cut hepatic segments / segments was exposed. Portal vein branches (portal vein tumor thrombus from the bile duct) into methylene blue staining, blocking the proposed resection of liver blood flow, according to the line of staining of liver lobes / segment resection. The 37 patients (observation group) were compared with 32 patients with liver cancer undergoing conventional hepatectomy (control group) during the same period. Results: The preoperative hepatic angiography and the intraoperative liver staining of 37 patients undergoing hepatectomy in the observation group were consistent. Compared with the control group, the operation time of the observation group was prolonged, the amount of hepatic hemorrhage, the change of liver function index, the fast recovery, the complication rate and the hospitalization time were shortened (all P <0.05). Conclusion: Dual-source CT angiography with three-dimensional reconstruction combined with regional blood flow blocking methylene blue staining can be used in precision hepatectomy to reduce bleeding and avoid the Glisson’s duct which is not injured by injury. It can reduce liver damage and complications.