三维重建技术在肝门部胆管癌术前评估中的价值

目的:探讨三维重建技术在肝门部胆管癌术前评估中的应用价值。方法:收集34例行联合肝切除肝门部胆管癌切除术患者的临床资料,其中15例术前行三维规划(观察组),19例未行三维规划(对照组),比较两组患者的相关手术指标;分析观察组依据三维重建确定的肿瘤分型与实际手术结果的相符度,以及二维及三维图像对肝体积评估的差异。结果:观察组平均术中出血量(525.4 m L vs.676.3 m L)、手术时间(5.0 h vs.5.8 h)、拔管时间(8.9 d vs.11.4 d)均较对照组明显减少(P=0.014、P=0.020、P=0.037),但两组术后住院时间和术后总并发症发生率差异无统计学意义(均P0.05)。观察组患者根据重建结果对肿瘤进行BismuthCorlette分型与实际结果比较符合度为86.7%(13/15);术前二维与三维计算出的平均肝切除体积差异无统计学意义(404.9 m L vs.411.2 m L,P0.05)。结论:三维重建可以完成对肝门部胆管癌的术前精确评估,对肝门部胆管癌手术治疗有一定的指导意义。

Value of three-dimensional reconstruction in preoperative assessment of hilar cholangiocarcinoma

Objective: To determine the application value of three-dimensional reconstruction in preoperative assessment of hilar cholangiocarcinoma. Methods: The clinical data of 34 patients with hilar cholangiocarcinoma undergoing hilar resection in combination with partial liver resection were collected. Of the patients, 15 cases had preoperative three-dimensional surgical planning (observational group), while 19 cases did not (control group). The relevant surgical variables between the two groups were compared. In observational group, the coincidence degree between tumor classifications from three-dimensional reconstruction data and postoperative actual findings, and the difference between two- and three-dimensional images for estimation of liver volume were analyzed. Results: In observational group versus control group, the average intraoperative blood loss (525.4 mL vs. 676.3 mL), operative time (5.0 h vs. 5.8 h) and time of tube removal (8.9 d vs. 11.4 d) were significantly reduced (P=0.014, P=0.020, and P=0.037), but the length of postoperative hospital stay and overall incidence of complications between the two groups had no statistical difference (both P>0.05). In observational group of patients, the coincidence rate of Bismuth-Corlette classification by three-dimensional reconstruction to actual results was 86.7% (13/15); the estimated liver resection volume calculated by the two- and three-dimensional techniques showed no statistical difference (404.9 mL vs. 411.2 mL, P>0.05). Conclusion: Three-dimensional reconstruction can provide a precise preoperative assessment for hilar cholangiocarcinoma, so it has certain guiding significance in surgical treatment of hilar cholangiocarcinoma.