探讨CT扫描三维重建可视化系统对原发性肝癌（肝癌）手术规划和术中指导的临床意义。

回顾性分析2016年3月至2017年3月解放军总医院收治的46例肝癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。根据术前评估方式将患者分为可视化组和对照组，可视化组男18例，女5例，平均年龄（61±9）岁；对照组男16例，女7例，年龄（60±9）岁。所有患者术前诊断均为肝癌。可视化组术前采用CT扫描三维重建可视化系统评估患者情况。观察两组患者在术式选择、手术时间、术中出血量以及术后并发症等方面的不同。手术时间、术中出血量等比较采用t检验，率的比较采用χ²检验，相关性分析采用Pearson相关分析。

三维重建可视化系统可准确显示肿瘤与脉管系统的关系，并发现解剖变异。可视化组患者的微创手术率为48%（11/23），明显高于对照组的17%（4/23） （χ²=4.85，P<0.05）。可视化组手术时间、术中出血量、住院时间分别为（128±38）min、（135±67）ml、（7.7±2.3）d，明显少于对照组的（205±56）min、（270±83）ml、（10.9±2.0）d（t=-5.37，-3.31，-4.92；P<0.05）。可视化组术后ALT、TB分别为（205±96）U/L、（12.2±2.4）μmol/L，明显低于对照组的（302±136）U/L、（18.5±3.8）μmol/L（t=-2.81，-6.67；P<0.05）。可视化组术前虚拟肝切除体积为（483±30）ml，与术中实际肝切除体积（437±30）ml，差异无统计学意义（t=1.13，P>0.05），二者呈正相关关系（r=0.814，P<0.05）。

CT三维重建可视化系统有助于肝癌患者术前安全性评估，关键解剖部位的定位及手术方案优化，指导精准肝切除。

To explore the clinical significance of CT three-dimensional reconstruction visualization system for surgical planning and intraoperative guidance for primary liver cancer (PLC).

Clinical data of 46 patients with PLC admitted to Chinese PLA General Hospital from March 2016 to March 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the visualization (n=23) and control groups (n=2). In visualization group, 18 patients were male and 5 were female with an average age of (61±9) years. In control group, 16 cases were male and 7 were female, aged (60±9) years on average. All patients were diagnosed with liver cancer before operation. In visualization group, CT D reconstruction visualization system was used for accessing the condition of patients before operation. The surgical procedure, operation time, intraoperative blood loss and postoperative complications of two groups were observed. The operation time and intraoperative blood loss were compare by t test. The rate comparison was conducted by Chi-square test. Correlation analysis was performed by Pearson correlation analysis.

D reconstruction visualization system could precisely display the relationship between tumors and vasculature and identify the anatomical variations. In visualization group, the percentage of undergoing minimally invasive surgery was 48% (11/23), significantly higher than 17% (4/23) in control group (χ2=4.85, P<0.05). In visualization group, the intraoperative operation time, blood loss and length of hospital stay were (128±38) min, (135±67) ml and (7.7±2.3) d, significantly less than (205±56) min, (270±83) ml and (10.9±2.0) d in control group (t=-5.37, -3.31, -4.92; P<0.05). The postoperative levels of ALT and TB in visualization group were (205±96) U/L and (12.2±2.4) μmol/L, significantly lower than (302±136) U/L and (18.5±3.8) μmol/L in the control group (t=-2.81, -6.67; P<0.05). In visualization group, the estimated volume of resected liver before operation was (483±30) ml, where no significant difference was observed compared with the actual intraoperative resected liver volume (437±30) ml (t=1.13, P>0.05), and a positive correlation was observed between them (r=0.814, P<0.05).

CT D reconstruction visualization system is useful for preoperative safety assessment, locating the key anatomical parts, optimizing surgical plans so as to conduct the precise hepatectomy.