切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2016, Vol. 05 ›› Issue (02) : 86 -90. doi: 10.3877/cma.j.issn.2095-3232.2016.02.006

所属专题: 文献

临床研究

三维可视化技术在联合肝脏离断和门静脉结扎的分阶段肝切除术中的应用
胡志刚1, 黄拼搏1, 李文滨1, 肖治宇1, 何传超1, 徐康1, 方驰华2, 王捷1,()   
  1. 1. 510260 广州,中山大学孙逸仙纪念医院肝胆外科
    2. 510282 广州,南方医科大学珠江医院肝胆一科
  • 收稿日期:2015-12-30 出版日期:2016-04-10
  • 通信作者: 王捷
  • 基金资助:
    国家自然科学基金(81372565)

Application of three-dimensional visualization technology in associating liver partition and portal vein ligation for staged hepatectomy

Zhigang Hu1, Pinbo Huang1, Wenbin Li1, Zhiyu Xiao1, Chuanchao He1, Kang Xu1, Chihua Fang2, Jie Wang1,()   

  1. 1. Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510260, China
    2. First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
  • Received:2015-12-30 Published:2016-04-10
  • Corresponding author: Jie Wang
  • About author:
    Corresponding author: Wang Jie, Email:
引用本文:

胡志刚, 黄拼搏, 李文滨, 肖治宇, 何传超, 徐康, 方驰华, 王捷. 三维可视化技术在联合肝脏离断和门静脉结扎的分阶段肝切除术中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2016, 05(02): 86-90.

Zhigang Hu, Pinbo Huang, Wenbin Li, Zhiyu Xiao, Chuanchao He, Kang Xu, Chihua Fang, Jie Wang. Application of three-dimensional visualization technology in associating liver partition and portal vein ligation for staged hepatectomy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(02): 86-90.

目的

探讨三维可视化技术在联合肝脏离断和门静脉结扎的分阶段肝切除术(ALPPS)中的应用价值。

方法

回顾性分析2014年12月中山大学孙逸仙纪念医院收治的1例应用三维可视化技术行ALPPS的肝细胞癌(肝癌)患者临床资料。患者女,44岁,因体检发现"转氨酶升高3个月,肝脏实性占位3 d"入院。既往有乙型病毒性肝炎(乙肝)病史。入院诊断:肝右叶巨块型肝癌。患者签署已知情同意书,符合医学伦理学规定。利用CT、医学图像三维可视化系统(MI-3DVS)进行术前评估及手术规划。

结果

一期术前三维可视化重建测得全肝体积1 033 ml,肝左叶体积195 ml,占标准肝体积的16%,一期手术结扎门静脉右支,分离左、右半肝。术后3周再行三维可视化重建测得全肝体积1 048 ml,肝左叶体积394 ml,占标准肝体积的33%。二期行右半肝切除术。术前三维可视化图像与术中所见相符,术前规划与实际手术相符。术后无明显并发症。

结论

三维可视化技术是ALPPS术前精确诊断及制定详细手术规划的良好辅助方法。

Objective

To explore the application value of three-dimensional visualization technology in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).

Methods

Clinical data of one patient with hepatocellular carcinoma (HCC) undergoing ALPPS using three-dimensional visualization technology were analyzed retrospectively. The patient was female, aged 44 years, was hospitalized due to transaminase elevation for 3 months and solid hepatic lesion for 3 d. She had a history of hepatitis B. She was diagnosed with massive HCC in the right liver lobe. The informed consents of the patient was obtained and the local ethical committee approval was received. Preoperative evaluation and surgical planning were performed using computer tomography (CT) scan and medical imaging three-dimensional visualization system (MI-3DVS).

Results

Total liver volume was 1 033 ml and the left lobe volume was 195 ml, accounting for 16% of the standard liver volume measured by three-dimensional visualization technology before the first-stage surgery. The right branch of portal vein was ligated and the left and right liver lobes were separated. Total liver volume was 1 048 ml and the left lobe volume was 394 ml, accounting for 33% of the standard liver volume measured by three-dimensional visualization technology 3 weeks after surgery. Right hemihepatectomy was performed during the second stage. The findings of preoperative three-dimensional visualization technology were consistent with intraoperative observation. Preoperative surgical planning was in accordance with intraoperative procedures. No apparent complication was observed after surgery.

Conclusion

Three-dimensional visualization technology is a favorable supplementary option for ALPPS in making the preoperative precise diagnosis and detailed surgical planning.

图1 一例肝癌患者ALPPS一期手术前肝脏三维可视化重建
图2 一例肝癌患者ALPPS二期手术前肝脏三维可视化重建
[1]
Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings[J]. Ann Surg, 2012, 255(3): 405-414.
[2]
de Santibañes E, Clavien PA. Playing Play-Doh to prevent postoperative liver failure: the "ALPPS" approach [J]. Ann Surg, 2012, 255(3): 415-417.
[3]
Zhang GQ, Zhang ZW, Lau WY, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): a new strategy to increase resectability in liver surgery[J]. Int J Surg, 2014, 12(5): 437-441.
[4]
Tanaka K, Matsuo K, Murakami T, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): short-term outcome, functional changes in the future liver remnant, and tumor growth activity [J]. Eur J Surg Oncol, 2015, 41(4):506-512.
[5]
Alvarez FA, Ardiles V, de Santibañes M, et al. Associating liver partition and portal vein ligation for staged hepatectomy offers high oncological feasibility with adequate patient safety: a prospective study at a single center[J]. Ann Surg, 2015, 261(4): 723-732.
[6]
Schadde E, Ardiles V, Slankamenac K, et al. ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis[J]. World J Surg, 2014, 38(6):1510-1519.
[7]
Nanashima A, Abo T, Sakamoto I, et al. Three-dimensional fusion images of hepatic vasculature and bile duct used for preoperative simulation before hepatic surgery[J]. Hepatogastroenterology, 2012, 59(118): 1748-1757.
[8]
杨剑,方驰华,范应方,等.三维可视化技术在合并肝动脉变异的胰十二指肠切除术中的应用[J].中华外科杂志,2014, 52(1): 55-59.
[9]
Aloia TA, Vauthey JN. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): what is gained and what is lost?[J]. Ann Surg, 2012 ,256(3):e9, e16-19.
[10]
Jain HA, Bharathy KG, Negi SS. Associating liver partition and portal vein ligation for staged hepatectomy: will the morbidity of an additional surgery be outweighed by better patient outcomes in the long-term?[J]. Ann Surg, 2012, 256(3): e10, e16-17.
[11]
Alvarez FA, Ardiles V, Sanchez Claria R, et al. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks[J]. J Gastrointest Surg, 2013, 17(4):814-821.
[12]
方驰华,刘文瑛,范应方,等.三维可视化技术指导经硬镜靶向碎石治疗肝胆管结石[J].中华外科杂志,2014, 52(2): 117-121.
[13]
Cavaness KM, Doyle MB, Lin Y, et al. Using ALPPS to induce rapid liver hypertrophy in a patient with hepatic fibrosis and portal vein thrombosis[J]. J Gastrointest Surg, 2013, 17(1):207-212.
[14]
Kokudo N, Shindoh J. How can we safely climb the ALPPS?[J]. Updates Surg, 2013, 65(3): 175-177.
[15]
Andriani OC. Long-term results with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)[J]. Ann Surg, 2012, 256(3): e5, e16-19.
[16]
Peterhans M, vom Berg A, Dagon B, et al. A navigation system for open liver surgery: design, workflow and first clinical applications[J]. Int J Med Robot, 2011, 7(1): 7-16.
[17]
Peterhans M, Oliveira T, Banz V, et al. Computer-assisted liver surgery: clinical applications and technological trends[J]. Crit Rev Biomed Eng, 2012, 40(3):199-220.
[18]
祝文,方驰华,范应方,等.原发性肝癌三维可视化诊治平台的构建及临床应用[J/CD].中华肝脏外科手术学电子杂志,2015,4(5):268-273.
[19]
苏琳,董蒨,张虹,等.3D可视化技术在婴幼儿复杂肝肿瘤精准肝切除中的应用[J/CD].中华肝脏外科手术学电子杂志,2015,4(5):274-278.
[20]
方驰华,李克晓,范应方,等.医学图像三维可视化系统在精准肝切除中的应用价值[J].中华消化外科杂志,2011, 10(1):29-32.
[1] 高俊颖, 张海洲, 区泓乐, 孙强. FOLFOX-HAIC 为基础的肝细胞癌辅助转化治疗的应用进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 457-463.
[2] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[3] 赖全友, 高远, 汪建林, 屈士斌, 魏丹, 彭伟. 三维重建技术结合腹腔镜精准肝切除术对肝癌患者术后CD4+、CD8+及免疫球蛋白水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 651-654.
[4] 李一帆, 朱帝文, 任伟新, 鲍应军, 顾俊鹏, 张海潇, 曹耿飞, 阿斯哈尔·哈斯木, 纪卫政. 血GP73水平在原发性肝癌TACE疗效评价中的作用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 825-830.
[5] 陆镜明, 韩大为, 任耀星, 黄天笑, 向俊西, 张谞丰, 吕毅, 王傅民. 基于术前影像组学的肝内胆管细胞癌淋巴结转移预测的系统性分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 852-858.
[6] 焦振东, 惠鹏, 金上博. 三维可视化结合ICG显像技术在腹腔镜肝切除术治疗复发性肝癌中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 859-864.
[7] 吴雪云, 胡小军, 范应方. 肝切除术中剩余肝再生能力的评估与预测[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 894-897.
[8] 林小勇, 张兰霞, 曾庆劲, 贺需旗, 谭雷, 郭光辉, 龙颖琳, 李凯, 吴宇轩. 负压抽吸活检针在肝困难病灶活检中的初步应用研究[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 694-698.
[9] 雷永琪, 刘新阳, 杨黎渝, 铁学宏, 俞星新, 耿志达, 刘雨, 陈政良, 惠鹏, 梁英健. 肝脏血管周上皮样细胞肿瘤合并贫血一例并文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 710-718.
[10] 欧阳佳裕, 李刚, 贺露瑶, 罗娜. 双层探测器光谱CT在早期原发性肝癌中的诊断价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 557-561.
[11] 陈志坚, 俞建达, 池小斌, 吕立志, 陈永标. 三维可视化技术在腹腔镜肝巨大肿瘤切除中的应用价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 302-307.
[12] 黄俊豪, 陈宗杰, 胡添松. 血小板相关参数对肝内胆管细胞癌根治性切除患者预后预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 308-312.
[13] 马欢欢, 马晨辉, 邓小博, 王博方, 何普毅, 王云鹏, 许博, 俞荣, 王娜, 陈昊. 肝癌实体瘤治疗疗效评价系统的研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 377-383.
[14] 王凯飞, 牟怡平, 李晓辉, 王瑞涛, 侯惠莲, 张月浪. 原发性肝平滑肌肉瘤临床病理特征及疗效分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 357-362.
[15] 张婵, 吕瑶, 张小燕, 张鸣青. 不同时机局部神经阻滞在开腹肝切除中的镇痛效果比较[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 189-194.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?