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目的研究智能CT(iCT)肝脏三维重建及模拟肝切除模型对临床规则肝切除的指导作用。方法将2008年6月至2009年12月需行根治性肝切除的肝癌患者47例分为iCT组(n=23)和常规组(n=24)。iCT组术前行philips 256层iCT肝脏容积和血管三维重建,并建立模拟临床解剖性肝切除模型,以此模型指导临床行解剖性肝切除;常规组根据二维CT图像采用同样的手术方式行解剖肝切除。结果两组术后输血率无明显差异(P>0.05),但iCT组失血量、输血量和手术耗时均明显少于常规组(P<0.05);iCT组和常规组残肝切缘癌细胞检出率为0%和4.2%;iCT组术后ALT恢复明显优于常规组(P<0.05),总胆红素和AFP的变化无差异(P>0.05);在(8.6±2.3)个月随访期间,iCT组生存率和复发率分别为100%和18.1%,明显优于常规组78.3%和47.8%(P=0.000和P=0.035)。结论建立iCT肝三维重建及模拟精准肝切除模型对临床具有良好的指导作用,有利于提高肝癌肝切除的临床功效。
Objective To study the guiding role of three-dimensional reconstruction of hepatic CT and hepatic resection model on clinical hepatectomy. Methods Forty-seven patients with hepatocellular carcinoma undergoing radical liver resection from June 2008 to December 2009 were divided into iCT group (n = 23) and conventional group (n = 24). iCT group preoperative philips 256 layer iCT liver volume and vascular three-dimensional reconstruction, and the establishment of simulated clinical anatomical liver resection model to guide the clinical anatomical liver resection; conventional group based on two-dimensional CT images using the same surgical approach Dissectable liver resection. Results There was no significant difference in transfusion rate between the two groups (P> 0.05). However, the blood loss, blood transfusion and operation time were significantly less in the iCT group than those in the conventional group (P <0.05) The positive rate of ALT in the iCT group was significantly higher than that in the conventional group (P <0.05), while there was no difference in total bilirubin and AFP (P> 0.05) During the follow-up period, the survival rate and recurrence rate in iCT group were 100% and 18.1%, respectively, which were significantly better than those in the conventional group (78.3% vs 47.8%, P = 0.000 and P = 0.035). Conclusion The establishment of three-dimensional reconstruction of iCT and accurate liver resection model has a good clinical guidance, which is helpful to improve the clinical efficacy of liver resection.