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目的总结肝脏三维手术模拟系统在复杂性肝脏肿瘤精准肝切除中的应用价值。方法回顾分析2009年5月-2014年6月云南省第一人民医院肝胆外科收治的85例复杂性肝脏肿瘤患者的临床资料。前瞻性研究对所有患者术前行肝脏CTA检查,应用三维手术模拟系统进行术前评估,分别计算模拟切除的肝脏体积、剩余肝脏体积和手术切缘,并与术后实际切除肝脏体积和实际手术切缘进行比较,最后通过软件虚拟肝切除功能优化手术方案。结果三维手术模拟系统可以清晰地显示和三维重建正常肝脏组织、肿瘤组织和肝内血管。患者模拟切除肝脏体积与实际切除肝脏体积统计学上具有相关性(P<0.01)。两者均值的差异无统计学意义(P=0.068)。模拟手术切缘与实际手术切缘统计学上也具有相关性(P<0.01),两者均值的差异也无统计学意义(P=0.256)。结论三维手术模拟系统可准确评估和模拟肝脏手术情况,为精准肝切除复杂性肝脏肿瘤提供手术数据和依据。
Objective To summarize the value of three-dimensional liver surgery simulation system in the hepatic resection of complex hepatic tumors. Methods The clinical data of 85 patients with complicated hepatic tumors who were admitted to Department of Hepatobiliary Surgery, First People ’s Hospital of Yunnan Province from May 2009 to June 2014 were retrospectively analyzed. All patients underwent prospective CTA examination of liver before surgery. Three-dimensional surgery simulation system was used for preoperative evaluation. The resected liver volume, residual liver volume and surgical margins were calculated and compared with actual resection of liver volume and actual operation Compared with the margins, and finally optimize the surgical program by software virtual liver resection function. Results Three-dimensional surgical simulation system can clearly display and three-dimensional reconstruction of normal liver tissue, tumor tissue and intrahepatic vessels. There was a statistically significant correlation between patient simulated resected liver volume and actual resected liver volume (P <0.01). The mean difference between the two groups was not statistically significant (P = 0.068). There was also a statistically significant correlation between simulated surgical margins and actual surgical margins (P <0.01), with no significant difference between the mean values (P = 0.256). Conclusion The three-dimensional surgical simulation system can accurately evaluate and simulate the operation of the liver and provide the surgical data and basis for the precise hepatectomy complicated liver tumor.