影像学三维可视化技术指导肝切除术治疗肝细胞癌患者临床疗效研究*

doi:10.3969/j.issn.1672-5069.2024.03.030

摘要/Abstract

摘要： 目的探讨应用影像学三维可视化技术(3DVT)指导肝切除术治疗肝细胞癌(HCC)患者的临床疗效。方法 2021年1月～2022年12月我院收治的HCC患者63例,被随机分为对照组31例和观察组32例,两组均行肝叶切除术治疗,对照组术前根据二维影像学图片表现制定手术方案,而观察组术前采用3DVT技术三维重建肿瘤图谱,并指导手术方案的制定。采用ELISA法检测血清白细胞介素-6(IL-6)、皮质醇(Cor)和C反应蛋白(CRP)水平。结果观察组手术时间、肝门阻断时间、术中出血量和术后住院日分别为(190.6±44.1)min、(13.8±3.3)min、(310.5±87.2)mL和(10.8±2.9)d,显著短于或少于对照组【分别为(228.3±56.9)min、(16.6±4.1)min、(399.2±96.92)mL和(13.3±3.5)d,P＜0.05】;在术后7 d,观察组血清TBIL、ALB和INR分别为(20.3±2.6)μmol/L、(38.2±3.9)g/L和(0.9±0.1),与对照组【分别为(18.8±3.2)μmol/L、(37.6±4.4)g/L和(0.9±0.2)】比,无统计学差异(P＞0.05);观察组血清IL-6、Cor和CRP水平分别为(106.8±19.2)pg/ml、(260.1±35.4)mmol/L和(28.6±4.8)mg/L,显著低于对照组【分别为(118.6±24.5)pg/ml、(291.6±40.7)mmol/L和(40.5±5.7)mg/L,P＜0.05】; 术后随访3个月,观察组感染、胆漏和肝衰竭等并发症发生率为6.2%,显著低于对照组的29.1%(P＜0.05)。结论应用3DVT技术指导肝切除术治疗HCC患者临床疗效确切,能缩短手术时间和肝门阻断时间,减少并发症发生,可能与激发的应激反应较轻有关,值得进一步研究。

关键词: 肝细胞癌, 肝叶切除术, 三维可视化技术, 治疗

Abstract: Objective The aim of this study was to explore the clinical application of imaging three-dimensional visualization technique (3DVT) in guidance of hepatectomy in patients with hepatocellular carcinoma (HCC). Methods 63 patients with HCC were encountered in our hospital between January 2021 and December 2022, and were randomly divided into control (n=31) and observation group (n=32). All patients in the two groups underwent laparoscopic hepatectomy (LH) and the difference was in the control, the operation was carried out based on routine CT or MR imaging, while in the observation group, the LH was finished based on the 3DVT reconstruction. Serum interleukin-6 (IL-6), cortisol (Cor) and C-reactive protein (CRP) levels were detected by ELISA. Results The operation time, hepatic inflow occlusion time, intraoperative blood loss and hospital stay in the observation group were(190.6±44.1)min, (13.8±3.3)min, (310.5±87.2)mL and (10.8±2.9)d, all significantly shorter or less than [(228.3±56.9)min, (16.6±4.1)min,(399.2±96.92)mL and (13.3±3.5)d, respectively, P＜0.05] in the control; at the end of 7 days after operation, serum bilirubin, albumin levels and INR in the observation were (20.3±2.6)μmol/L, (38.2±3.9)g/L and (0.9±0.1), all not significantly different as compared to [(18.8±3.2)μmol/L, (37.6±4.4)g/L and (0.9±0.2)] in the control (P＞0.05); serum IL-6, Cor and CRP levels were (106.8±19.2)pg/ml, (260.1±35.4)mmol/L and (28.6±4.8)mg/L, all much lower than [(118.6±24.5)pg/ml, (291.6±40.7)mmol/L and (40.5±5.7)mg/L, respectively, P＜0.05] in the control; 3 months after surgery, the incidence of complications, such as infection, bile leakage and liver failure in the observation was 6.2%, much lower than 29.1%(P＜0.05) in the control group. Conclusion The advantage of LH under the guidance of 3DVT is terrific in patients with HCC, which could shorten operation time and hepatic inflow occlusion time, and is worthy of further clinical investigation.

Key words: Hepatocellular carcinoma, Hepatectomy, Three-dimensional visualization technique, Therapy

闫振, 赵博文, 林国英, 殷和良. 影像学三维可视化技术指导肝切除术治疗肝细胞癌患者临床疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 438-441.

Yan Zhen, Zhao Bowen, Lin Guoying, et al. Clinical application of imaging three-dimensional visualization technique in guidance of hepatectomy in patients with hepatocellular carcinoma[J]. Journal of Practical Hepatology, 2024, 27(3): 438-441.

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影像学三维可视化技术指导肝切除术治疗肝细胞癌患者临床疗效研究^*

Clinical application of imaging three-dimensional visualization technique in guidance of hepatectomy in patients with hepatocellular carcinoma

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