探讨三维重建在中晚期原发性肝癌（肝癌）转化切除中的应用价值。

回顾性分析2019年12月至2020年7月贵州医科大学附属医院收治的2例中晚期肝癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。例1男，52岁，因"反复上腹部疼痛3个月"入院。右上腹压痛阳性。上腹部增强CT：肝Ⅴ、Ⅵ段肝细胞癌。入院初步诊断：肝癌，中国肝癌分期（CNLC）Ⅲa期。例2女，58岁，因"体检发现肝占位5 d"入院。上腹部增强CT：肝Ⅶ、Ⅷ段肝癌并周围多发子灶形成伴门静脉右支受侵。入院初步诊断：肝癌，CNLCⅢa期。2例患者术前均行CT三维重建评估，右半肝切除手术风险极大，故行TACE联合抗HBV等转化治疗。

例1患者行2周期TACE治疗后复查上腹部CT示肿瘤体积缩小，肿瘤对静脉压迫改善。例2患者行3周期TACE治疗后复查上腹部CT示肿瘤体积显著缩小，肿瘤对门静脉右支压迫减轻。CT三维重建后评估可行肝癌肝切除。2例患者分别行肝癌Ⅴ、Ⅵ段切除术和Ⅶ、Ⅷ段切除术。术后行TACE辅助治疗。2例患者均未发生急性肝衰竭、胆漏、小肝综合征等术后并发症，且随访满1年均未发现肿瘤复发转移。

三维重建能提供客观数据评估中晚期肝癌患者初始手术方案风险和转化治疗效果，同时指导手术方案设计。

To evaluate the application value of three-dimensional reconstruction in the conversion resection of advanced primary liver cancer (PLC).

Clinical data of 2 patients with advanced PLC admitted to the Affiliated Hospital of Guizhou Medical University from December 2019 to July 2020 were retrospectively analyzed. The informed consents of 2 patients were obtained and the local ethical committee approval was received. Patient 1: male, aged 52, was admitted to our hospital due to "recurrent upper abdominal pain for 3 months". The right upper quadrant tenderness was reported. Contrast-enhanced CT scan of the upper abdomen detected hepatocellular carcinoma in segment Ⅴ and Ⅵ. The patient was initially diagnosed with China Liver Cancer Staging (CNLC) Ⅲa liver cancer. Patient 2: female, aged 58, was admitted to our hospital due to "space-occupying lesion of the liver for 5 d during physical examination". Contrast-enhanced CT scan of the upper abdomen detected liver cancer in segment Ⅶ and Ⅷ complicated with multiple surrounding foci and involvement of the right branch of portal vein. The initial diagnosis was CNLC Ⅲa liver cancer. Preoperative evaluation were performed in 2 patients with CT three-dimensional reconstruction, which indicated a high risk for right hemihepatectomy. Therefore, TACE combined with anti-HBV conversion therapies were adopted.

After 2 courses of TACE, CT scan of the upper abdomen showed that the tumor volume was decreased and the venous compression was alleviated in patient 1. For patient 2, CT scan of the upper abdomen revealed that the tumor volume was significantly reduced and the relationship between the tumor and the right branch of portal vein compression was alleviated after 3 courses of TACE. CT three-dimensional reconstruction indicated that it was feasible to perform hepatectomy afterward.2 patients underwent resection of segment Ⅴ and Ⅵ, Ⅶ and Ⅷ, respectively. Postoperative TACE adjuvant therapy was given. No postoperative complications, such as acute liver failure, bile leakage and small liver syndrome occurred in two patients. No tumor recurrence or metastasis was reported during 1-year follow-up.

Three-dimensional reconstruction can provide objective information to evaluate the risk of initial surgical regimen and the efficacy of conversion therapy for patients with advanced PLC, and help to make the surgical plan.