Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Division of Pediatric Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Pediatr Transplant. 2020 May;24(3):e13675. doi: 10.1111/petr.13675. Epub 2020 Feb 18.
We utilized patient-specific 3D liver models based on preoperative computed tomography images as intraoperative navigation and describe our experience. A 1-year and 10-month-old girl with situs inversus totalis underwent living donor liver transplantation for biliary atresia. Information on the hepatic artery, portal vein, inferior vena cava, and liver parenchyma was extracted and segmented from computed tomography images using liver analysis software. Laser lithography produced each 3D part of the liver from these data. The 3D models of each part of the liver were molded from polyurethane resin using different colors for each part and combined together, resulting in a patient-specific liver model. The industrial computed tomography scan of the patient-specific 3D liver model revealed that the gaps between the liver model and the original data were <0.4 mm in the 90% area, <0.8 mm in the 98% area, and 1.53 mm at the maximum. The 3D liver model was brought into the operative field and used as intraoperative navigation for total liver resection. The procedure was finished successfully without any major intraoperative complications. In conclusion, the 3D model facilitates the identification of vessels during operations; it is possible to promptly share patients' anatomy with the operative team.
我们利用基于术前计算机断层扫描图像的患者特异性 3D 肝脏模型作为术中导航，并介绍我们的经验。一名患有完全性内脏反位的 1 岁零 10 个月大的女孩因胆道闭锁接受活体供肝移植。使用肝脏分析软件从 CT 图像中提取并分割肝动脉、门静脉、下腔静脉和肝实质的信息。激光光刻术根据这些数据生成每个肝脏的 3D 部分。使用不同颜色对每个部分的肝脏 3D 模型进行塑形，并将它们组合在一起，形成患者特异性的肝脏模型。对患者特异性 3D 肝脏模型的工业 CT 扫描显示，肝模型与原始数据之间的间隙在 90%的区域<0.4mm，在 98%的区域<0.8mm，最大间隙为 1.53mm。将 3D 肝脏模型带入手术区域，并用作全肝切除术的术中导航。手术顺利完成，没有出现任何重大术中并发症。总之，3D 模型有助于在手术中识别血管；可以及时与手术团队共享患者的解剖结构。
