探讨三维可视化系统（MI-3DVS软件系统）在肝门部胆管癌术前评估和手术规划中的应用价值。

本前瞻性研究对象为2009年6月至2013年12月在南方医科大学珠江医院应用MI-3DVS软件进行术前评估的13例肝门部胆管癌患者。所有患者均签署知情同意书，符合医学伦理学规定。其中男8例，女5例；年龄34～81岁，中位年龄55岁。采用64排或256排螺旋CT进行肝、胆、胰、脾和腹腔血管等增强扫描，采集患者平扫期、动脉期、门静脉期和静脉期的4套医学数字成像和数据。将患者各期数据导入MI-3DVS，进行图像分割和三维重建。对重建图像进行可视化处理后，观察肿瘤与肝内胆管、肝动脉、门静脉系统和肝静脉系统的三维立体关系，并进行Bismuth-Corlette分型，模拟手术并制定手术方案。

13例患者的重建模型均准确显示肝脏形态及其管道系统的解剖标志，肝门部胆管癌、肝内各种管道系统等结构形态逼真，立体感强，各分支走向清晰。根据三维重建结果对肿瘤进行Bismuth-Corlette分型，Ⅲa型1例，Ⅲb型7例，Ⅳ型5例。术前三维重建对肿瘤分型诊断准确率100%（13/13）。模拟手术与实际手术方式符合率为85%（11/13）。患者的手术时间为630（300～720）min，术中出血量420（110～1 800）ml；手术并发症发生率23%（3/13），其中切口感染2例，胆漏1例，均经保守治疗痊愈。

三维可视化系统能准确、直观、动态地显示肝门部胆管癌及其三维毗邻关系，可对患者进行准确的术前评估和手术规划。

To investigate the application value of three-dimensional visualization system (MI-3DVS software system) in the preoperative evaluation and surgical planning for hilar cholangiocarcinoma.

Thirteen patients with hilar cholangiocarcinoma undergoing preoperative evaluation with MI-3DVS software in Zhujiang Hospital, Southern Medical University between June 2009 and December 2013 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 13 patients, 8 were males and 5 were females with the age ranging from 34 to 81 years old and the median of 55 years old. Enhanced scan of liver, gallbladder, pancreas, spleen and blood vessels in abdominal cavity was performed on the patients with 64-slice or 256-slice spiral CT. Four sets of medical digital imaging and data of plain scan phase, arterial phase, portal venous phase and venous phase were collected. The data of each phase were introduced into MI-3DVS to perform image segmentation and three-dimensional reconstruction. The three-dimensional relationship between tumor and intrahepatic bile duct, hepatic artery, portal venous system and hepatic venous system was observed after the reconstructed images were visualized and Bismuth-Corlette classification was determined for the tumors. Moreover, surgery was simulated and surgical planning was formulated.

The reconstructed models of 13 patients all exactly displayed the shape of liver and anatomic landmark of duct system. The structure and shape of hilar cholangiocarcinoma and various intrahepatic duct systems were realistic and stereoscopic and the direction of various branches was clear. Bismuth-Corlette classification of tumors was determined according to the results of three-dimensional reconstruction. One case was type Ⅲa, 7 were type Ⅲb and 5 were type Ⅳ. The accuracy rate of tumor classification was 100%(13/13) by preoperative three-dimensional reconstruction. The coincidence rate of simulated surgery and actual operative procedure was 85% (11/13). The median operation time was 630 (300~720) min and the intraoperative blood loss was 410 (110~1 800) ml. The incidence of surgical complications was 23% (3/13). Two patients developed incision infection and 1 developed bile leakage. All were cured with conservative treatment.

Three-dimensional visualization system may accurately, directly and dynamically display the hilar cholangiocarcinoma and its three-dimensional adjacent relation, which may be used to perform accurate preoperative evaluation and surgical planning for patients.