探讨三维可视化技术在原发性肝癌（肝癌）肝切除术前评估中的应用价值。

回顾性分析2015年1月至2017年12月海军军医大学长征医院收治的80例肝癌肝切除患者临床资料。其中男57例，女23例；平均年龄（51±7）岁。患者均签署知情同意书，符合医学伦理学规定。术前行三维可视化重建评估40例，设为三维重建组；电脑随机抽样选取40例未行三维可视化重建的患者作为对照组。分析两组患者围手术期指标和并发症发生情况。两组血流阻断时间和出血量比较采用秩和检验或t检验。两组围手术期肝功能指标比较采用重复测量资料的方差分析。术后并发症发生率、肿瘤复发率等比较采用χ²检验或似然比χ²检验。

三维重建组解剖性肝切除术比例为68%（27/40），明显高于对照组的43%（17/40） （χ²=5.051，P<0.05）；而手术标本切缘阳性率为0，明显低于对照组的10%（4/40） （χ²=5.756，P<0.05）；并发症发生率为13%（5/40），亦明显低于对照组的33%（13/40） （χ²=4.588，P<0.05）。三维重建组血流阻断时间中位数为9 （0～14）min，明显短于对照组的12（0～15）min（U=1165.5，P<0.05）；术中出血量为（406±21）ml，亦明显少于对照组的（549±23）ml（t=-4.977，P<0.05）。两组术后TB、ALT、ALB比较显示，三维重建组肝功能指标较对照组恢复快（F=7.408，30.410，25.434；P<0.05）。

三维可视化技术有助于准确评估肝癌肝切除术风险，制定最佳个体化手术方案，可以提高肝切除手术安全性，降低术后并发症发生率。

To explore the application value of three-dimensional (3D) visualization in the preoperative evaluation of hepatectomy for primary liver cancer (PLC).

Clinical data of 80 patients with PLC treated in Shanghai Changzheng Hospital of the Second Military Medical University from January 2015 to December 2017 were retrospectively analyzed. Among them, 57 cases were male and 23 female, aged (51±7) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. 40 patients receiving preoperative 3D visualization reconstruction and evaluation were assigned into the 3D reconstruction group. 40 patients who didn't undergo 3D visualization reconstruction were randomly selected by computer into the control group. Perioperative parameters and postoperative complications were statistically compared between two groups. The blood occlusion time and intraoperative blood loss were statistically compared between two groups by rank-sum test or t test. Perioperative liver function parameters were statistically compared between two groups by ANOVA of repeated measurement data. The incidence of postoperative complications and tumor recurrence rate were compared by Chi-square test or likelihood ratio Chi-square test.

The proportion of anatomical hepatectomy in 3D reconstruction group was 68%(27/40), significantly higher than 43%(17/40) in control group (χ2=5.051, P<0.05). However, the rate of positive surgical margin in 3D reconstruction group was 0, significantly lower than 10%(4/40) in control group (χ2= 5.756, P<0.05). The incidence of postoperative complications in 3D reconstruction group was 13%(5/40), significantly lower than 33%(13/40) in the control group (χ2=4.588, P<0.05). In 3D reconstruction group, the median blood occlusion time was 9(0-14) min, significantly shorter than 12(0-15) min in control group (U=1165.5, P<0.05). Intraoperative blood loss was (406±21) ml, considerably less than (549±23) ml in control group (t=-4.977, P<0.05). The liver function parameters including TB, ALT and ALB in 3D reconstruction group recovered faster than those in control group (F=7.408, 30.410, 25.434; P<0.05).

3D visualization contributes to accurate assessment of the risk of hepatectomy for PLC patients and formulating the optimal individualized surgical plan, which can also improve the safety of hepatectomy and reduce the incidence of postoperative complications.