[1]方驰华,方兆山,范应方,等.三维可视化、3D打印及3D腹腔镜在肝肿瘤外科诊治中的应用[J].南方医科大学学报,2015,(05):639.
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三维可视化、3D打印及3D腹腔镜在肝肿瘤外科诊治中的应用()
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《南方医科大学学报》[ISSN:/CN:]

卷:
期数:
2015年05期
页码:
639
栏目:
出版日期:
2015-05-15

文章信息/Info

Title:
Application of 3D visualization, 3D printing and 3D laparoscopy in the diagnosis and
surgical treatment of hepatic tumors
作者:
方驰华方兆山范应方李鉴轶向飞陶海粟
关键词:
三维可视化3D打印3D腹腔镜肝肿瘤解剖性肝切除术
Keywords:
three-dimensional visualization 3D printing 3D laparoscopy hepatic tumors anatomical hepatectomy
摘要:
目的研究三维可视化、3D打印、3D腹腔镜(3-3D技术)在肝脏肿瘤外科诊治中的应用价值。方法收集2013年11月~2015年
1月22例肝脏肿瘤患者资料,首先进行上腹部薄层CT扫描,收集CT数据,然后利用MI-3DVS软件进行三维可视化、肝脏脉管
分型、虚拟肝切除等术前规划。将三维可视化的STL文件打印3D物理模型,进行肝预切除面界定。采用3D腹腔镜进行解剖性
肝切除。观察手术时间、术中出血量、实际肝切除体积、术后住院时间。结果肝动脉按Michels分型:Ⅰ型19例,Ⅱ型2例,Ⅷ型
1例;门静脉按Cheng分型:Ⅰ型17例,Ⅱ型2例,Ⅲ型2例,Ⅳ型1例。肝静脉根据Nakamura分型:Ⅰ型10例,Ⅱ型7型,Ⅲ型5例。
虚拟切除肝体积490±228 ml,残肝体积885±139 ml;残肝体积与功能肝体积之比0.71±0.11。3D打印模型立体显示了肝肿瘤和脉
管的空间关系。20例完成腹腔镜肝切除术,2例中转开腹。手术时间186±92 min,术中出血量284±286 ml,实际切除肝体积491±
192 ml,术后住院时间为8.6±3.7 d。结论3-3D技术有助于术前安全评估、关键解剖部位的定位、实时导航手术和解剖性肝切除术。
Abstract:
Objective To study the value of three-dimensional (3D) visualization, 3D printing and 3D laparoscopy (3-3D
techniques) in the diagnosis and surgical treatment of hepatic tumors. Methods From November 2013 to January 2015, 22
patients with hepatic tumors admitted in our department underwent abdominal thin-slice CT scanning. The CT images were
imported into Medical Image three Dimensional Visualization System (MI-3DVS) for 3D reconstruction. Standard Template
Library (STL) files were exported for 3D printing. The hepatic vascular classification and predicted liver resection were
performed with the aid of MI-3DVS system. The 3D models were then printed and virtual liver resections were executed
accordingly. Based on these preoperative surgical planning data, we performed anatomical hepatectomy using 3D laparoscopy,
and the intraoperative blood loss, volume of virtual and actual liver resection and postoperative hospital stay were recorded.
Results According to Michels’s classifications, 19 patients had type I, 2 had type II, and 1 had type VIII hepatic arteries; based
on Cheng classifications, the portal vein was classified into type I in 17 cases, type II in 2 cases, and type III in 2 cases, and type
IV in 1 case; according to Nakamura classifications, the right hemiliver hepatic vein was classified into type I in 10 cases, type
II in 7 cases, and type III in 5 cases. In the virtual operations, the mean volume of liver resected was 490±228 ml and the mean
remnant liver volume was 885±139 ml, with a remnant to functional liver volume ratio of (71±11)%. The 3D printed models
stereoscopically displayed the location of the liver tumors and adjacent liver vascular structure clearly. Laparoscopic
hepatectomy was performed successfully in 20 patients guided by the 3-3D techniques, and the other 2 patients required
convertion to open hepatectomy. The mean operation time was 186±92 min, the intraoperative blood loss was 284±286 ml, the
mean actual liver resection volume was 491±192 ml, and the mean postoperative hospital stay of the patients was 8.6±3.7 days.
Conclusions The 3-3D technique can facilitate the evaluation of preoperative risk and critical anatomical structures and
navigate the surgical procedure in real time in anatomical hepatectomy for hepatic tumors.

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[2]黄华军,张国栋,欧阳汉斌,等.基于3D打印技术的复杂胫骨平台骨折内固定手术数字化设计[J].南方医科大学学报,2015,(02):218.
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更新日期/Last Update: 1900-01-01