探讨三维可视化技术在精准肝切除术前规划中的应用价值。

回顾性分析2013年1月至2013年12月在南方医科大学珠江医院肝胆一科行精准肝切除的19例肝细胞癌（肝癌）患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男15例，女4例；平均年龄（45±4）岁。患者术前经64排CT扫描，获取亚毫米扫描数据，导入三维可视化软件MI-3DVS中，分别进行图像分割、三维重建、肝脏个体化分段、体积计算、设计虚拟切除平面、制定手术规划。

全部患者进行了肝脏三维重建、肝脏分段、体积计算，重建肝内血管分支均达到三级以上，能清晰显示肝内各血管系统立体解剖形态、肝脏个体化分段及肿瘤部位、大小、数量。术中所见与术前三维重建符合率100%（19/19）。根据个体化三维重建结果制定术前规划，实际手术过程与术前手术规划符合率100% (19/19)。手术顺利，围手术期无发生死亡，6例术后胸腔积液，经引流治愈。

三维可视化技术可实现肝脏肿瘤的术前精确诊断，手术规划帮助术中精确操作。

To explore the application value of three-dimensional (3D) visualization technology in preoperative planning of precise hepatectomy.

Clinical data of 19 patients (15 males, 4 females; mean age: 45±4) with hepatocelular carcinoma (HCC) undergoing precise hepatectomy in First Department of Hepatobilliary Surgery, Zhujiang Hospital of Southern Medical University from January 2013 to December 2013 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. The patients received 64-slice CT scan before operation to get the sub-millimeter CT scan data, then the data were imported into the 3D visualization software MI-3DVS. The image segmentation, 3D reconstruction, individual liver segmentation, volume calculation, virtual resection plane design, surgical planning were conducted respectively.

All the patients underwent 3D reconstruction of liver, liver segmentation and volume calculation. The reconstruction results showed that the interhepatic vasculatures can be indentified to over level 3. The 3D anatomical morphology of interhepatic vascular system, individual liver segmentation, tumor location, size and quantity could be clearly displayed. The compliance rate of the actual intraoperative findings and preoperative 3D reconstruction results was 100% (19/19). The preoperative plan was defined according to the individual 3D reconstruction results. And the compliance rate of the actual operative process and preoperative plan was 100% (19/19). All the operations were performed successfully and no death case occurred during the perioperative period. Six patients suffered hydrothorax after operation and were cured by drainage.

Three-dimensional visualization technology is helpful for the accurate preoperative diagnosis of liver tumors, and the surgical planning benefits the precise operation.