探讨三维可视化技术在腹腔镜肝巨大肿瘤切除中的安全性和疗效。

回顾性分析2016年7月至2021年6月在第九〇〇医院行肝巨大肿瘤切除术的50例患者临床资料。其中男19例，女31例；年龄38～65岁，中位年龄45岁。患者均签署知情同意书，符合医学伦理学规定。肿瘤直径10～17 cm，中位直径13 cm；良性肿瘤23例，恶性肿瘤27例。根据手术方法不同分为两组，其中联合组24例，采用三维可视化技术联合腹腔镜；对照组26例，采用开腹肝巨大肿瘤切除术。两组术中及术后情况比较采用t检验或χ²检验。生存分析采用Kaplan-Meier法和Log-rank检验。

两组手术均顺利，联合组无中转开腹。联合组术后第1天C-反应蛋白中位数为26（18，72） mg/L，明显低于对照组的57（44，81）mg/L（Z=-2.700，P<0.05）；术后第1天平均术后肛门排气时间、术后下床活动时间、术后住院时间分别为（2.6±0.8）、（3.1±1.3）、（13±4）d，明显低于对照组的（3.1±1.1）、（4.4±1.6）、（16±6）d（t=-2.180，-3.137，-2.062；P<0.05）。联合组术后并发症发生率为25%（6/24），对照组为42%（11/26），差异无统计学意义（χ²=1.666，P>0.05）。联合组恶性肿瘤术后1、3、5年总体生存率和无瘤生存率分别为78.8%、52.5%、26.3%和57.1%、28.6%、0，对照组相应为70.6%、36.4%、12.1%和51.3%、22.0%、0，差异均无统计学意义（χ²=0.292，0.764；P>0.05）。

三维可视化技术可对腹腔镜肝巨大肿瘤切除患者进行术前精准评估，术中指导精确操作，降低炎症反应，加速术后康复。

To evaluate the safety and efficacy of three-dimensional visualization technology in laparoscopic resection of huge liver tumors.

Clinical data of 50 patients who underwent huge liver tumor resection in No. 900 Hospital from July 2016 to June 2021 were retrospectively analyzed. Among them, 19 patients were male and 31 female, aged from 38 to 65 years, with a median age of 45 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The tumor diameter was ranged from 10 to 17 cm, with a median diameter of 13 cm. 23 patients were diagnosed with benign tumors and 27 cases of malignant tumors. According to different surgical methods, they were divided into two groups. In the combination group, 24 cases underwent three-dimensional visualization technology combined with laparoscopic resection. In the control group, 26 cases were treated with open resection of huge liver tumors. Intraoperative and postoperative conditions of patients betweentwo groups were compared by t test or Chi-square test. Survival analysis was performed by Kaplan-Meier analysis and Log-rank test.

All patients in two groups successfully completed the surgery, and no conversion to open surgery was reported in the combination group. In the combination group, the median C-reactive protein level at postoperative 1 d was 26(18, 72) mg/L, significantly lower than 57(44, 81) mg/L in the control group (Z=-2.700, P<0.05). At postoperative 1 d, the average time to first flatus, postoperative ambulation time and the length of postoperative hospital stay were (2.6±0.8), (3.1±1.3) and (13±4) d, significantly shorter than (3.1±1.1), (4.4±1.6) and (16±6) d in the control group (t= -2.180, -3.137, -2.062; P<0.05). The incidence of postoperative complications in the combination group was 25% (6/24) and 42% (11/26) in the control group, with no statistical significance between two groups (χ²=1.666, P>0.05). The postoperative 1-, 3- and 5-year overall survival and disease-free survival rates in the combination group were 78.8%, 52.5%, 26.3% and 57.1%, 28.6%, 0, and 70.6%, 36.4%, 12.1% and 51.3%, 22.0%, 0 in the control group, with no statistical significance between two groups (χ²=0.292, 0.764; P>0.05).

Three-dimensional visualization technology can be utilized to deliver accurate preoperative evaluation for patients undergoing laparoscopic resection of huge liver tumors, and to guide accurate intraoperative operation, thus mitigating inflammatory reactions and accelerating postoperative rehabilitation.