Su Lin, Zhou Xian-Jun, Dong Qian, Zhang Hong, Shen Feng, Chen Yong-Jian, Hao Xi-Wei, Li Xiao-Fei
Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University Qingdao, China.
Qingdao Hisense Medical Device Co. Ltd Qingdao, China.
Int J Clin Exp Med. 2015 Oct 15;8(10):18406-12. eCollection 2015.
We discussed the diagnostic and treatment value and clinical significance of computer assisted surgery system (Higemi) in precision surgeries for pediatric complex liver tumors. A total of 21 pediatric cases receiving hepatectomy for tumors in the portal vein and giant liver tumors from June 2012 to January 2015 were analyzed. Higemi was used for 3-dimensional (3D) reconstruction of thin-slice CT images and surgical planning. Tumors were precisely located and blood vessel neighborhood was determined so as to evaluate surgical feasibility. In addition, pathological classification, surgical time, intraoperative blood loss, transfusion rate and complications were predicted. After 3D reconstruction using Higemi, the neighboring relationship of tumors with blood vessels and the running direction of the blood vessels were clearly visualized. Of 21 cases, 10 cases had tumors located in the left lobe, 5 cases in the right lobe, 3 cases showing involvement of right trilobes, and 3 cases in the middle lobe. Lobes exceeding one third of the total liver volume were resected in 18 cases. Postoperative pathological examination indicated 10 cases of hepatoblastoma, 3 cases of hepatocellular carcinoma, 3 cases of hamartoma, 3 cases of infantile hemangioendothelioma, 1 case of teratoma and 1 case of undifferentiated malignant mesenchymoma. The surgical time was 90-240 min with an average of 130 min; the medium intraoperative blood loss was 60 ml and the minimum blood loss was 3 ml; the transfusion rate was 42.9% (9/21). Surgeries were successful in 20 cases, who were discharged after recovery. However, one case had giant liver tumor combined with severe obstructive jaundice and hepatic insufficiency and died of postoperative liver failure and DIC. 3D reconstruction of CT data using Higemi can clearly visualize the running direction of blood vessels and the neighboring relationship with tumors. Higemi can improve the precision and safety of complex hepatectomy.
我们探讨了计算机辅助手术系统（Higemi）在小儿复杂肝脏肿瘤精准手术中的诊断、治疗价值及临床意义。分析了2012年6月至2015年1月期间共21例因门静脉肿瘤及巨大肝脏肿瘤接受肝切除术的小儿病例。使用Higemi对薄层CT图像进行三维（3D）重建及手术规划。精确确定肿瘤位置及血管毗邻关系，以评估手术可行性。此外，还对病理分类、手术时间、术中出血量、输血率及并发症进行了预测。使用Higemi进行3D重建后，肿瘤与血管的毗邻关系及血管走行清晰可见。21例中，10例肿瘤位于左叶，5例位于右叶，3例累及右三叶，3例位于中叶。18例切除的肝叶超过全肝体积的三分之一。术后病理检查显示肝母细胞瘤10例，肝细胞癌3例，错构瘤3例，婴儿型血管内皮瘤3例，畸胎瘤1例，未分化恶性间叶瘤1例。手术时间为90 - 240分钟，平均130分钟；术中平均出血量为60毫升，最少出血量为3毫升；输血率为42.9%（9/21）。20例手术成功，康复后出院。然而，1例巨大肝脏肿瘤合并严重梗阻性黄疸及肝功能不全，术后死于肝衰竭及弥散性血管内凝血。使用Higemi对CT数据进行3D重建可清晰显示血管走行及与肿瘤的毗邻关系。Higemi可提高复杂肝切除术的精准性及安全性。
