探讨三维可视化技术在巨块型肝细胞癌（肝癌）精准肝切除患者中的应用价值。

本前瞻性研究对象为2014年1月至2016年1月安徽医科大学附属省立医院收治的64例巨块型肝癌肝切除患者。患者均签署知情同意书，符合医学伦理学规定。根据患者和家属意愿，将患者为精准组和传统组。精准组34例，男28例，女6例；平均年龄（54±6）岁；传统组30例，男26例，女4例；年龄（56±7）岁。精准组术前采取CT三维可视化技术对肝脏体积、肿瘤位置及大小、与邻近血管的关系进行精确评估，规划和模拟手术方案。在彩色多普勒超声引导下采用超声吸引刀（CUSA）或超声刀行精准肝切除。术后根据加速康复外科理念给予护理。传统组术前行常规CT或MRI等检查，肝切除方法以钳夹法为主，采用Pringle法阻断第一肝门，术后按照常规护理及康复治疗。两组患者术中情况及术后肝功能检查比较采用t检验，率的比较采用χ²检验。

精准组手术时间中位数为229（57～352）min，明显多于传统组的138（61～282）min（Z=1.752，P<0.05）。精准组术后1 d ALT、AST分别为425（24～1 299）、390（15～1 484）U/L，明显低于传统组的574（42～3 533）、670（76～3 795）U/L（Z=-2.099，-2.677；P<0.05）。精准组术后住院时间为6.2（3.0～19.0）d，明显少于传统组的9.5（5.0～30.0）d（Z=-2.387，P<0.05）。精准组术后发生并发症3例，传统组9例，差异有统计学意义（χ²=4.691，P<0.05）。精准组无发生死亡，传统组1例死于术后肝衰竭。

与常规肝切除相比，采用三维可视化技术精准肝切除治疗巨块型肝癌，具有手术创伤小、安全性高、术后恢复快的优势。

To evaluate the application of three-dimensional visualization technique in precise hepatectomy for patients with massive hepatocellular carcinoma (HCC).

64 patients with massive HCC who underwent hepatectomy in Anhui Provincial Hospital Affiliated to Anhui Medical University between January 2014 and January 2016 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the will of patients and their families, these patients were divided into precise group and conventional group. There were 34 cases in precise group, including 28 males and 6 females, with an average age of (54±6) years old. There were 30 cases in conventional group, including 26 males and 4 females, with an average age of(56±7) years old. In precise group, liver volume, tumor location and size and relation with the adjacent vessels were assessed precisely, and surgical protocol was planned and simulated using CT three-dimensional visualization technique before operation. Precise hepatectomy was performed using cavitron ultrasound surgical aspirator (CUSA) or ultrasonic scalpel with the guidance of color Doppler ultrasound. Patients were treated according to the concept of enhanced recovery after surgery after operation. Patients in conventional group received routine CT or MRI before operation, liver resection with clamping method was performed and the porta hepatis was occluded using Pringle maneuver during the operation. Patients received routine nursing and rehabilitation treatments after operation. Intraoperative situation and postoperative liver function of patients between both groups were compared by t test, and the rates were compared by Chi-square test.

The median length of operation was 229(57-352) min in precise group, significantly more than 138(61-282) min in conventional group (Z=1.752, P<0.05). The postoperative 1 d ALT and AST was respectively 425(24-1 299) and 390(15-1 484) U/L in precise group, significantly lower than574(42-3 533) and 670(76-3 795) U/L in conventional group (Z=-2.099, -2.677; P<0.05). The postoperative length of hospital stay was 6.2(3.0-19.0) d in precise group, significantly less than 9.5(5.0-30.0) d in conventional group (Z=-2.387, P<0.05). Postoperative complications occurred in 3 patients in precise group and 9 patients in conventional group, where significant difference was observed (χ²=4.691, P<0.05). No death case was observed in precise group, while 1 case died of postoperative liver failure in conventional group.

Compared with conventional liver resection, three-dimensional visualization technique can be used in precise hepatectomy for patients with massive HCC. It has the advantages of less trauma, higher safety and faster postoperative recovery.