探讨三维可视化及3D打印技术在复杂肝脏肿瘤诊治中的应用价值。

回顾性分析2016年1月至2019年10月宁夏医科大学总医院收治的30例复杂肝脏肿瘤患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男20例，女10例；年龄24～74岁，中位年龄51岁。术前腹部增强CT扫描，采用三维可视化系统进行三维重建，3D打印1∶1物理模型。术前通过三维图像及模型仔细研究肿瘤与周围重要血管关系，并进行模拟切除，制定个体化诊疗方案。观察手术及术后并发症等情况。模拟切除肝脏体积与实际切除肝脏体积比较采用t检验。

所有患者均完成三维重建，其中10例获取3D打印模型。重建肝内血管均达到3级以上，可清晰显示肿瘤立体解剖形态、部位及与周围血管关系。发现肝动脉变异3例，肝静脉变异4例，门静脉分支受肿瘤侵犯2例。肝脏平均体积（1 779±325）ml，肝脏肿瘤体积（572±238）ml。术前模拟手术方案与术中实际手术方案符合率为100%（30/30）。模拟切除肝脏体积为（896±405）ml，实际切除肝脏体积为（815±270）ml，差异无统计学意义（t=0.205，P>0.05）。手术时间（288±66）min，术中出血量（722±390）ml，住院时间（20±6）d。术后胸腔积液10例，胆漏3例。无发生围手术期死亡，无大量出血、肝衰竭等严重并发症。

三维可视化及3D打印技术应用于肝脏复杂肿瘤的术前规划和肝切除术更加精准、安全、有效。

To evaluate the application of 3D visualization and 3D printing in the diagnosis and treatment of complex liver tumors.

Clinical data of 30 patients with complex liver tumors admitted to General Hospital of Ningxia Medical University from January 2016 to October 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 20 patients were male and 10 female, aged 24-74 years with a median age of 51 years. Abdominal enhanced CT scan was performed before operation. 3D reconstruction was carried out using 3D visualization system. 1:1 physical model was constructed by 3D printer. Prior to operation, the relationship between tumors and surrounding vessels was analyzed through the 3D images and physical model. Simulated resection was performed and individualized diagnosis and treatment regimes were designed. Operative conditions and postoperative complications were observed. The simulated resected liver volume was compared with the actual resected liver volume by t test.

3D reconstructions of all the patients were completed, and 3D printed models of 10 cases were obtained. The intrahepatic vessels of grade Ⅲ and above were reconstructed. The relationship among the 3D anatomical morphology, location of tumors and its relation with the surrounding blood vessels could be explicitly displayed. 3 patients were with hepatic artery variations, 4 cases with hepatic vein variations and 2 cases with portal vein branches invaded by tumors. The mean liver volume was (1 779±325) ml, and the liver tumor volume was (572±238) ml. The consistency rate between preoperative simulated surgery and the actual surgery was 100%(30/30). The simulated resected liver volume was (896±405) ml, which did not differ from (815±270) ml of the actual resected liver volume (t=0.205, P>0.05). The operation time was (288±66) min, intraoperative blood loss was (722±390) ml, and the length of hospital stay was (20±6) d. Postoperative pleural effusion occurred in 10 patients and bile leakage in 3 cases. No perioperative death, massive bleeding, liver failure or other severe complications were observed.

3D visualization and 3D printing is precise, safe and effective in preoperative design and resection of complex liver tumors.