Yamanaka Junichi, Saito Shinichi, Fujimoto Jiro
First Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
World J Surg. 2007 Jun;31(6):1249-55. doi: 10.1007/s00268-007-9020-8.
Accurate assessment of resection volume and vascular anatomy is mandatory in preoperative planning for safe and curative hepatectomy to treat cancer. Accordingly, we examined feasibility and accuracy of a preoperative three-dimensional (3D) computed tomography (CT) scan based simulation in patients with impaired liver function undergoing hepatectomy for hepatocellular carcinoma (HCC).
Hepatectomy simulation software was programmed to reconstruct detailed 3D vascular structure and calculate liver volume based on hepatic circulation. In 113 patients with HCC, liver resection volume was estimated preoperatively by both simulation and conventional planimetry. For validation, predicted resection volumes were compared with actual resected specimen weights. The resection margin as estimated by the simulation was compared with the margin in the specimen.
Simulation showed higher correlation and smaller discrepancy (r = 0.96; 9.3 ml) between predicted and actual liver resection volume than conventional planimetry (r = 0.74; 174 ml). Simulation showed correlation (p < 0.01) between estimated and actual segmental volume, which was not measurable by planimetry. Simulation showed a correlation (r = 0.84) between predicted and actual margin, with a difference of 1.6 mm.
Hepatectomy simulation in 3D predicted segmental liver volume and the resection margin accurately. This virtual method should contribute to preoperative planning to achieve safe, curative resection in HCC patients, whose hepatic function is compromised.
在肝癌肝切除术的术前规划中，准确评估切除体积和血管解剖结构对于安全有效的手术治疗至关重要。因此，我们研究了基于术前三维（3D）计算机断层扫描（CT）扫描的模拟技术在肝功能受损的肝细胞癌（HCC）患者肝切除术中的可行性和准确性。
编写肝切除模拟软件，以重建详细的三维血管结构并根据肝循环计算肝脏体积。对113例肝癌患者，术前通过模拟和传统的平面测量法估算肝切除体积。为进行验证，将预测的切除体积与实际切除标本的重量进行比较。将模拟估算的切缘与标本中的切缘进行比较。
与传统平面测量法（r = 0.74；174 ml）相比，模拟显示预测和实际肝切除体积之间具有更高的相关性和更小的差异（r = 0.96；9.3 ml）。模拟显示估算和实际节段体积之间具有相关性（p < 0.01），而平面测量法无法测量。模拟显示预测和实际切缘之间具有相关性（r = 0.84），差异为1.6 mm。
三维肝切除模拟可准确预测节段性肝体积和切缘。这种虚拟方法应有助于术前规划，以实现对肝功能受损的肝癌患者进行安全、有效的切除。
