探讨三维可视化技术在严重肝外伤救治中的临床应用价值。

回顾性分析2014年1月至2017年1月在解放军联勤保障部队第900医院收治的12例严重肝外伤患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男10例，女2例；年龄19～56岁，中位年龄40岁。肝右叶损伤9例，肝中叶损伤1例，肝左叶损伤2例。美国创伤外科学会的器官损伤分级（AAST-OIS）分级Ⅲ级2例，Ⅳ级8例，Ⅴ级2例。采用64排螺旋CT扫描行肝脏三维可视化重建，评估损伤、血管累及情况，初步评估腹腔出血量，拟定救治方案。评价三维可视化技术应用情况及患者疗效。

三维重建模型可清晰显示肝内脉管系统，包括门静脉、肝动静脉的走行，分支，空间构象及损伤区域所累及的肝段，可任意角度观察损伤区域与其周围脉管结构的空间解剖关系，准确地对损伤部位进行定位和分级，术前三维重建结果与术中真实情况一致。12例患者均按救治前设计方案顺利进行肝外伤的救治。4例开腹探查，探查情况与术前评估一致；6例行数字减影血管造影（DSA）介入治疗，2例密切观察保守治疗。1例肝右叶巨大血肿破裂，术后肾衰竭，长期间断血液净化治疗，余11例患者术后未发生并发症，顺利出院。

对于严重肝外伤患者，三维可视化技术能对损伤部位和累及血管进行准确的评估，并辅助设计最优治疗方案，指导个体化救治方案的实施。

To evaluate the clinical application of three-dimensional visualization in the treatment of severe liver trauma.

Clinical data of 12 patients with severe liver trauma admitted to the 900^th Hospital of the Joint Logistics Support Force of PLA from January 2014 to January 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 10 patients were male and 2 female, aged 19-56 years with a median age of 40 years. 9 patients were diagnosed with the right lobe injury, 1 case of middle lobe injury and 2 cases of left lobe injury. According to American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS), 2 cases were classified as grade Ⅲ,8 were grade Ⅳ and 2 were grade Ⅴ. Three-dimensional visualization reconstruction was performed with 64-slice spiral CT scan to evaluate the injury and vascular involvement. The amount of abdominal hemorrhage was evaluated initially. The therapeutic regime was determined. The application of three-dimensional visualization and the curative effect were evaluated.

The three-dimensional reconstruction model could clearly display the hepatic vascular system including the courses of portal vein, hepatic artery and vein, the branches, spatial conformation as well as the injury-involved liver segments. It could observe the spatial anatomical relationship between the injured region and its surrounding vascular structure at any angle, and accurately locate and classify the injured site. Preoperative three-dimensional reconstruction results were consistent with the intraoperative findings. All 12 patients were successfully treated according to the preoperative therapeutic regime. 4 patients underwent open exploration, and the findings were consistent with the preoperative evaluation. 6 cases underwent interventional therapy by digital subtraction angiography (DSA). 2 patients received conservative therapy and were monitored closely. 1 patient suffered from rupture of a giant hematoma in the right lobe and renal failure after operation, and was treated with long-term intermittent blood purification. The remaining 11 cases were discharged without postoperative complications.

For patients with severe liver trauma, three-dimensional visualization can accurately evaluate the injured site and vascular involvement, contribute to design the optimal therapeutic regime and guide the implementation of individualized treatments.