探讨多模态影像技术在精准肝切除治疗原发性肝癌（肝癌）中的临床应用价值。

回顾性分析2018年1月至2021年1月粤北人民医院行精准肝切除的69例肝癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男52例，女17例；年龄21~77岁，中位年龄55岁。根据术前采用数字医学影像技术不同，将患者分为多模态影像技术指导组（多模组，32例）和三维可视化技术指导组（单模组，37例）。多模组采用三维可视化重建、3D打印、增强现实（AR）技术指导多模块进行术前评估、手术规划和手术导航。单模组术前采用三维可视化技术进行术前规划。比较两组患者围手术期情况及预后。两组手术时间、术中出血量等比较采用t检验或秩和检验，率的比较采用χ²检验。

69例患者均成功建立三维可视化重建模型。多模组术中所见与三维可视化、3D打印及AR技术一致，手术团队对手术方案理解和手术配合高度一致。所有患者均顺利完成手术，无围手术期死亡，术后均未发生严重并发症。多模组平均手术时间、入肝血流阻断时间分别为（203±59）、（27±13）min，明显少于单模组的（235±62）、（34±13）min（t=-2.193，-2.178；P<0.05）；术中出血量中位数分别为165（235）ml，亦明显少于单模组的200（100）ml（Z=-2.472，P<0.05）。单模组术后复发转移4例，多模组3例，两组无复发生存率比较差异无统计学意义（χ²=0.032，P>0.05）。

多模态影像技术具有多信息化优势，可弥补单一模式的不足，通过精准的术前规划和手术导航，可提高精准肝癌肝切除术的精准性和安全性。

To evaluate the clinical application value of multi-modality imaging in precise resection for primary liver cancer (PLC).

Clinical data of 69 patients with PLC who underwent precise liver resection in Yuebei People's Hospital from January 2018 to January 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 52 patients were male and 17 female, aged from 21 to 77 years, with a median age of 55 years. According to different digital medical imaging techniques used preoperatively, all patients were divided into the multi-modality imaging guiding group (multi-modality group, n=32) and three-dimensional (3D) visualization guiding group (single-modality group, n=37). In the multi-modality group, 3D visualization reconstruction, 3D printing and augmented reality (AR) were employed for preoperative evaluation, surgical planning and surgical navigation. In the single-modality group, 3D visualization was utilized for surgical planning before operation. Perioperative conditions and clinical prognosis were compared between two groups. The operation time and intraoperative blood loss between two groups were statistically compared by t test or rank-sum test. The rate comparison was conducted by Chi-square test.

3D visualization reconstruction models were successfully established for 69 patients. In the multi-modality group, intraoperative findings were consistent with those of 3D visualization, 3D printing and AR. Understanding on the surgical plan was highly consistent with the cooperation of the surgical team. All patients successfully completed the surgery. No perioperative death and severe postoperative complications were observed. In the multi-modality group, the average operation time and hepatic blood inflow occlusion duration were (203±59) min and(27±13) min, significantly shorter than (235±62) min and (34±13) min in the single-modality group (t=-2.193, -2.178; P<0.05). In the multi-modality group, the median intraoperative blood loss was 165(235) ml, significantly less than 200(100) ml in single-modality group (Z=-2.472, P<0.05). In the single-modality group, 4 cases developed postoperative recurrence and metastases and 3 cases in the multi-modality group. No significant difference was noted in the recurrence-free survival rate between two groups (χ²=0.032, P>0.05).

Multi-modality imaging possesses the advantage of multi-informatization and resolves the limitations of single-modality imaging. Besides, it can improve the accuracy and safety of precise resection for PLC through accurate preoperative planning and intraoperative navigation.