探讨3D可视化技术在婴幼儿复杂肝肿瘤精准肝切除中的应用价值。

回顾性分析2012年6月至2015年1月在青岛大学附属医院采用3D可视化技术行复杂肝肿瘤精准肝切除术的16例婴幼儿临床资料。其中男10例，女6例；年龄22 d～3岁，中位年龄1岁2个月。12例瘤体巨大累及相应的肝门部；4例为原发于肝门部位的肿瘤。所有患儿家属均签署知情同意书，符合医学伦理学规定。采用64排螺旋CT对患儿进行检查，将扫描数据导入计算机辅助手术系统（Higemi）中进行三维重建，并计算剩余肝脏与标准化全肝体积比值（RSLVR）。根据三维重建图像，术前进行精准肝切除术规划。

经Higemi三维重建后可清晰显示肝内脉管系统，包括门静脉、肝动脉及肝静脉的走行、分支和空间构象，可任意角度观察病灶与其周围脉管结构的空间解剖关系，准确地对病变进行定位和评估。术前三维重建结果与术中实际情况一致。16例患儿均按术前设计方案顺利进行了肝切除术。RSLVR中位数为44.7%（21.1%～78.4%），手术时间145（90～230）min，术中出血量60 （3～100） ml，输血率38%（6/16）。1例肝右叶巨大肿瘤患儿术后发生弥散性血管内凝血，积极治疗无效后死亡，余15例患儿无发生术后并发症，顺利出院。

对于婴幼儿复杂肝肿瘤，3D可视化技术能对肿瘤进行准确的术前评估，并辅助设计最优手术方案，使婴幼儿复杂肝肿瘤肝切除更加精准、安全、有效。

To investigate the application value of 3D visualization technology in precise hepatectomy for complex liver tumors in infants.

Clinical data of 16 infants undergoing precise hepatectomy for complex liver tumors with 3D visualization technology in the Affiliated Hospital of Qingdao University between June 2012 and January 2015 were retrospectively studied. Among the 16 infants, 10 were boys and 6 were girls with the age ranging from 22 d to 3 years old and the median of 1 year and 2 months old. Twelve patients were with giant tumors involving the corresponding porta hepatis and four patients were with primary tumor at porta hepatis. The informed consents of all infants were obtained from their parents and the local ethical committee approval had been received. The infants were examined by 64-slice spiral CT. The scanning data were imported into the computer-aided surgery system (Higemi) to perform 3D reconstruction and to compute remnant liver volume and remnant-standard liver volume ratio (RSLVR). The preoperative plan of precise hepatectomy was formulated according to the 3D reconstruction images.

After Higemi 3D reconstruction, the intrahepatic vasculature, including the distribution, branching and spatial conformation of portal vein, hepatic artery and hepatic veins were clearly displayed. The anatomic spatial relationships between the lesions and the surrounding vascular structures could be observed at any angle, and lesions could be located and assessed accurately. The preoperative 3D reconstruction results were in accordance with the intraoperative findings. Sixteen infants underwent hepatectomy successfully according to the preoperative plan. The median RSLVR was 44.7% (21.1%-78.4%), the duration of operation was 145 (90-230) min, the intraoperative blood loss was 60 (3-100) ml and the rate of blood transfusion was 38% (6/16). One infant with giant tumor in the right liver lobe developed disseminated intravascular coagulation and died although active treatment. The other 15 infants had no complication and were discharged successfully.

For complex liver tumors of infants, 3D visualization technology can assess the tumors accurately before surgery and help to make the optimum surgical plan, which makes hepatectomy for complex liver tumors of infants more precise, safe and effective.