计算机辅助手术规划在成人对成人活体肝移植中的应用：有多大帮助？单中心经验。

Computer-assisted surgical planning in adult-to-adult live donor liver transplantation: how much does it help? A single center experience.

机构信息

Department of General, Thoracic and Transplantation Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.

出版信息

Transplantation. 2012 Dec 15;94(11):1138-44. doi: 10.1097/TP.0b013e31826e5970.

DOI:10.1097/TP.0b013e31826e5970

PMID:23222737

Abstract

BACKGROUND

Preoperative imaging and donor selection are cardinal components of adult-to-adult live donor liver transplantation (ALDLT). The purpose of this study was to evaluate our three-dimensional (3D) computed tomography image-derived computer-assisted surgical planning (3D CASP) in ALDLT.

METHODS

Eighty-three consecutive ALDLTs (71 right and 12 left) were planned with 3D CASP. Graft, remnant, and total liver volume compliance were calculated and compared with actual intraoperative values. Computed risk analysis encompassing territorial liver mapping, functional (safely drained) volumes, and outflow congestion volumes in grafts and remnants allowed for the individualized management of the middle hepatic vein (MHV).

RESULTS

Graft volume compliance was 13.5%±4.4%. Three small-for-size (SFS) grafts with lethal SFS syndrome (SFSS) had nonsignificant volume compliance with maximal graft volume-body weight ratios of less than 0.83. Seven SFS grafts with reversible or absent SFSS showed maximal graft volume-body weight ratios of 0.9 to 1.16. Significant differences were identified for (a) virtual graft and remnant congestion volumes of risky versus nonrisky MHV types (49%±6% and 34%±7% vs. 29%±8% and 33%±12%, P<0.001 and P<0.02, respectively) and (b) virtual mean functional versus surgical volumes of grafts (527±119 vs. 963±176 mL, P<0.0001) and remnants (419±182 vs. 640±213 mL, P<0.001).

CONCLUSIONS

CASP allowed for (a) prevention of SFSS in extremely small grafts by predicting donor liver plasticity and (b) individualized MHV management for both donors and recipients based on functional graft/remnant volume analysis.

摘要

背景

术前影像学检查和供体选择是成人对成人活体肝移植（ALDLT）的关键组成部分。本研究旨在评估我们的三维（3D）计算机断层扫描图像衍生的计算机辅助手术规划（3D CASP）在 ALDLT 中的应用。

方法

83 例连续的 ALDLT（71 例右半肝和 12 例左半肝）采用 3D CASP 进行规划。计算并比较了移植物、残肝和总肝体积的顺应性与实际术中值。计算风险分析包括区域性肝段划分、功能性（安全引流）体积和移植物及残肝流出道淤血体积，以实现对中肝静脉（MHV）的个体化管理。

结果

移植物体积的顺应性为 13.5%±4.4%。3 例小体积肝移植（SFS）伴致命小肝综合征（SFSS）的供体肝体积，最大肝移植体积与体重比（GVWR）均小于 0.83，体积顺应性无显著差异。7 例具有可逆或不存在 SFSS 的 SFS 移植物，GVWR 为 0.9 至 1.16。在以下方面存在显著差异：（a）风险型与非风险型 MHV 类型的虚拟移植物和残肝淤血体积（49%±6%和 34%±7%比 29%±8%和 33%±12%，P<0.001 和 P<0.02）；（b）虚拟供肝功能与手术实际体积（527±119 比 963±176 毫升，P<0.0001）和残肝（419±182 比 640±213 毫升，P<0.001）。