探讨混合现实（MR）技术在腹腔镜肝切除术中导航的应用价值。

回顾性分析2019年9月至2022年1月在云南省第一人民医院行腹腔镜肝切除术的60例肝占位性病变患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男27例，女33例；年龄25~72岁，中位年龄50岁。根据患者是否采用MR技术，分为MR组（30例）和非MR组（NMR组，30例）。MR组采用昆华微乐MR手术导航系统引导进行腹腔镜肝切除术，NMR组接受常规二维影像术前规划。观察两组围手术期情况和术后复发情况。两组手术时间、术中出血量等数据比较采用Mann-Whitney U检验；术后并发症发生率、复发率比较采用χ²检验。

MR组手术时间、术中出血量中位数分别为170 （123）min、125（268）ml，明显少于NMR组的300（183）min、250（550）ml（Z=-4.182，-2.287；P<0.05）。MR组术后输血率为17%（5/30），明显低于NMR组的37%（11/30） （χ²=5.079，P<0.05）。MR组术后住院时间为8（6）d，明显短于NMR组的11（5）d（Z=-3.120，P<0.05）。MR组和NMR组术后并发症发生率分别为37%（11/30）、53%（16/30），差异无统计学意义（χ²=1.684，P>0.05）。患者随访时间3~24个月，中位随访时间9个月。随访期间MR组复发6例，NMR组复发9例，差异无统计学意义（χ²=0.800，P>0.05）。

对于腹腔镜肝切除术患者，术中MR技术可实现术前精准评估、术中实时导航，该技术应用可明显减少手术时间、术中出血量，降低输血率，有助于提高手术精准性、安全性和可行性。

To evaluate the application value of mixed reality (MR) technology in the navigation of laparoscopic hepatectomy.

Clinical data of 60 patients with liver lesions who underwent laparoscopic hepatectomy in the First People's Hospital of Yunnan Province from September, 2019 to January, 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 27 patients were male and 33 female, aged from 25 to 72 years, with a median age of 50 years. All patients were divided into the MR group (n=30) and non-MR group (NMR group, n=30) according to whether MR technology was employed. In the MR group, laparoscopic hepatectomy was performed under the guidance of Kunhua Weile MR-based surgical navigation system, and conventional two-dimensional imaging was used for preoperative planning in the NMR group. Perioperative conditions and postoperative recurrence were observed in two groups. The data between two groups, such as operation time and intraoperative blood loss, were compared by Mann-Whitney U test. The incidence of postoperative complications and recurrence rates were compared by Chi-square test.

In the MR group, the median operation time and intraoperative blood loss were 170(123) min and 125(268) ml,significantly less than 300(183) min and 250(550) ml in the NMR group (Z=-4.182, -2.287; P<0.05). Postoperative blood transfusion rate in the MR group was 17%(5/30), significantly lower than 37%(11/30) in the NMR group (χ²=5.079, P<0.05). In the MR group, the length of postoperative hospital stay was 8(6) d,significantly shorter compared with 11(5) d in the NMR group (Z=-3.120, P<0.05). The incidence rates of postoperative complications in the MR and NMR groups were 37%(11/30) and 53%(16/30), and no significant difference was observed (χ²=1.684, P>0.05). All patients were followed up for 3-24 months, with a median of 9 months. During the follow-up, 6 cases recurred in the MR group and 9 in the NMR group, and no significant difference was observed (χ²=0.800, P>0.05).

For patients undergoing laparoscopic hepatectomy, intraoperative MR technology can realize accurate preoperative evaluation and real-time intraoperative navigation. Application of MR technology can significantly shorten the operation time, reduce intraoperative blood loss and lower blood transfusion rate, thus helps to improve the surgical precision, safety and feasibility.