探讨三维可视化技术在腹腔镜肝巨大肿瘤术前评估中的应用价值。

回顾性分析2017年1月至2020年12月解放军联勤保障部队第900医院行腹腔镜肝巨大肿瘤切除术的24例患者临床资料。其中男10例，女14例；平均年龄（48±5）岁。原发性肝癌10例，肝血管瘤12例，肝局灶性结节性增生2例。患者均签署知情同意书，符合医学伦理学规定。术前患者获取二维CT图像，导入三维可视化软件中，分别对肝脏、肝动脉系统、门静脉系统、肝静脉系统及肿瘤行图像分割和三维重建。根据三维重建结果进行手术规划，设定肝脏预切除平面，选择合理的手术路径及方式。

24例患者均顺利完成三维可视化模型重建，三维重建可清楚显示肝内各血管系统解剖、肿瘤具体位置、大小及其与血管的毗邻关系。三维可视化测算全肝体积为2 732（2 325~2 964）ml，肝肿瘤体积1 366（1 145~1 758）ml，预切除肝体积1 595（1 108~1 806）ml，评估剩余肝体积与标准肝体积比值46.7%（41.4%~62.2%）。24例患者均成功完成腹腔镜肝巨大肿瘤切除术。实际手术路径及方式与术前手术规划符合率100%。肝恶性肿瘤和局灶性结节性增生患者实际切除肝体积1 602（1 203~1 806）ml，与术前评估预切除肝体积符合率100%。术中出血量700（100~2 000）ml，术后并发症发生率25%（6/24），术后无严重肝功能不全及死亡。

三维可视化技术可对肝巨大肿瘤切除进行术前精准评估，帮助术中精确操作，提高腹腔镜肝巨大肿瘤切除手术规划的准确性和安全性。

To evaluate the application value of three-dimensional visualization in the evaluation of giant liver tumors before laparoscopic resection.

Clinical data of 24 patients who underwent laparoscopic resection of giant liver tumors in the 900^th hospital of PLA Joint Logistics Support Force from January 2017 to December 2020 were retrospectively analyzed. Among them, 10 patients were male and 14 female, aged (48±5) years on average. 10 patients were diagnosed with primary liver cancer, 12 cases with hepatic hemangioma and 2 cases with focal nodular hyperplasia of the liver. The informed consents of all patients were obtained and the local ethical committee approval was received. Preoperatively, two-dimensional CT images were collected and imported into three-dimensional visualization software. The images of liver, hepatic artery system, portal vein system, hepatic vein system and tumors were subjected to image segmentation and three-dimensional reconstruction. Surgical plan was determined according to three-dimensional reconstruction results. The resection plane of the liver was pre-designed. Appropriate surgical routes and patterns were selected.

All 24 patients successfully completed three-dimensional visualization model reconstruction. Three-dimensional reconstruction could clearly display the anatomy of various vascular systems in the liver, the exact location and size of the tumor and its adjacent relationship with blood vessels. Three-dimensional visualization detected that the total liver volume was 2 732(2 325-2 964) ml, the liver tumor volume was 1 366(1 145-1 758) ml, and the pre-resected liver volume was 1 595(1 108-1 806) ml. The estimated ratio of the remaining liver volume to standard liver volume was 46.7%(41.4%-62.2%). All 24 patients successfully completed laparoscopic resection of giant liver tumors. The consistence rate between the actual surgical routes and procedures, and preoperative plans was 100%. The actual resected liver volume of patients with malignant liver tumors and focal nodular hyperplasia was 1 602(1 203-1 806) ml, which was 100% consistent with the pre-resected liver volume before operation. The intraoperative blood loss was 700(100- 2 000) ml. The incidence of postoperative complications was 25%(6/24). No severe hepatic insufficiency or death occurred after operation.

Three-dimensional visualization can deliver accurate evaluation of giant liver tumors before laparoscopic resection, facilitate precise intraoperative procedures, and enhance the accuracy and safety of laparoscopic resection of giant liver tumors.