Chen L, Luo H P, Dong S L, Chen X P
Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China.
Zhonghua Wai Ke Za Zhi. 2016 Sep 1;54(9):669-74. doi: 10.3760/cma.j.issn.0529-5815.2016.09.005.
To explore the effectiveness of three-dimentional(3D)reconstruction technique in safety assessment of hepatectomy for large hepatocellular carcinoma(HCC).
The clinical records of 28 patients who underwent resection of HCC greater than 10 cm in diameter from January 2013 to December 2015 at Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology were studied retrospectively. All patients underwent enhanced computer tomography (CT), then 3D images of liver and tumor were reconstructed by uploading the CT imaging data to IQQA-Liver system. The individual surgery plan was simulated and liver volume (LV), standard liver volume(LV), tumor volume(TV), functional liver volume(FLV), excised liver volume(ELV), excised functional liver volume (EFLV), residual functional liver volume (RELV) were calculated. Simulated surgery plans were compared with actual procedures. ELV was compared with actual excised liver volume (AELV) by paired Student's t test. Postoperative complications and motility were analyzed. The correlation between TV and EFLV, RFLV, RFLV/FLV, RFLV/SLV were calculated by Spearman test.
TV ranged from 202 cm(3) to 2 125 cm(3,) RELV ranged from 401 cm(3) to 1 633 cm(3).There were 13 patients whose RFLV/LV<30% and 28 patients whose RFLV/FLV>30%(34.8%-94.0%). RFLV/SLV ranged from 35.9% to 139.0%.All simulated surgery plans matched with the actual operation procedure. ELV was equal to AELV, which confirmed by the high precision of IQQA-Liver system(t=0.636, P>0.05). No severe complications (hepatic encephalopathy or liver failure) and perioperative death occurred after operation. Positive correlation was observed between TV and RFLV, TV and RFLV/FLV, TV and RFLV/SLV(r=0.641, 0.629 and 0.732, all P<0.01). Negative correlation was observed between TV and EFLV (r=-0.539, P<0.01).
3D reconstruction technique could accurately simulate surgery procedure, calculate liver volume and evaluate the safety of hepatectomy for huge hepatocellular carcinoma. When the anatomical liver resection was performed, the larger tumor volume means the smaller excision functional liver volume and larger residual liver volume.
探讨三维（3D）重建技术在大肝细胞癌（HCC）肝切除安全性评估中的有效性。
回顾性研究2013年1月至2015年12月在华中科技大学同济医学院附属同济医院肝脏外科接受直径大于10 cm HCC切除术的28例患者的临床资料。所有患者均接受增强计算机断层扫描（CT），然后将CT成像数据上传至IQQA-Liver系统重建肝脏和肿瘤的3D图像。模拟个体化手术方案并计算肝体积（LV）、标准肝体积（SLV）、肿瘤体积（TV）、功能性肝体积（FLV）、切除肝体积（ELV）、切除功能性肝体积（EFLV）、残余功能性肝体积（RELV）。将模拟手术方案与实际手术过程进行比较。通过配对t检验比较ELV与实际切除肝体积（AELV）。分析术后并发症和活动情况。通过Spearman检验计算TV与EFLV、RFLV、RFLV/FLV、RFLV/SLV之间的相关性。
TV范围为202 cm³至2125 cm³，RELV范围为401 cm³至1633 cm³。有13例患者RFLV/LV<30%，28例患者RFLV/FLV>30%（34.8% - 94.0%）。RFLV/SLV范围为35.9%至139.0%。所有模拟手术方案均与实际手术过程相符。ELV等于AELV，IQQA-Liver系统的高精度证实了这一点（t = 0.636，P>0.05）。术后未发生严重并发症（肝性脑病或肝衰竭）及围手术期死亡。TV与RFLV、TV与RFLV/FLV、TV与RFLV/SLV之间呈正相关（r = 0.641、0.629和0.732，均P<0.01）。TV与EFLV之间呈负相关（r = -0.539，P<0.01）。
3D重建技术可准确模拟手术过程，计算肝体积并评估巨大肝细胞癌肝切除的安全性。进行解剖性肝切除时，肿瘤体积越大，切除的功能性肝体积越小，残余肝体积越大。
