南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (03): 297-307.doi: 10.12122/j.issn.1673-4254.2020.03.16

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复杂性肝脏肿瘤切除三维可视化精准诊治指南（2019版）

中华医学会数字医学分会；中国医师协会肝癌专业委员会；中国医师协会临床精准医学专业委员会；中国研究型医院学会数字智能化外科专业委员会   

  • 出版日期:2020-04-08 发布日期:2020-03-20
  • 基金资助:

Clinical practice guidelines for precision diagnosis and treatment of complex liver tumor guided by three-dimensional visualization technology (version 2019)

  

  • Online:2020-04-08 Published:2020-03-20

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摘要： 基于肝脏三维可视化的虚拟肝切除在中国得到越来越广泛的应用，为肝脏肿瘤精确诊断、术前评估、手术规划和术中精准指导提供了安全而有效的方法，该技术在复杂性肝脏肿瘤诊治中的技术优势及重要意义也已逐渐得到认可。为规范三维可视化技术在复杂性肝脏肿瘤的精准诊疗中的应用，本指南对以下几个方面进行了研究：（1）三维重建同质化处理与质控体系的建立；（2）个体化腹腔器官和病灶的三维可视化模型的建立；（3）三维可视化个体化血管分型和量化分析；（4）复杂性肝脏肿瘤肝脏血管三维可视化分型、分级；（5）三维可视化模型建立后的手术模拟评估体系；（6）三维可视化肝脏3D打印在复杂性肝切除术的应用；（7）虚拟现实技术；（8）ICG分子荧光成像；（9）多模图像融合实时导航技术；（10）三维可视化指导精准复杂性肝切除术的术前规划；（11）三维可视化技术对肝癌其他治疗手段的指导作用；（12）三维可视化技术对肝癌手术后复查的指导作用。肝脏三维可视化技术为复杂性肝脏肿瘤的术前精准评估病情、术前规划、手术导航等实施提供了新的方法，为病人获得最佳的康复效果发挥强而有力的支持作用，具有重要的临床应用价值。

Abstract: Virtual resection of liver structures guided by three-dimensional visualization technology (3DVT) has been extensively used in China. This technique provides a safe and effective method for accurate diagnosis of liver tumors and has important applications in preoperative evaluation, surgical planning and intraoperative guidance of liver cancer surgeries. The technical advantages and clinical significance of 3DVT in the diagnosis and treatment of complex liver tumors have been recognized. In order to standardize the application of 3DVT in the precision diagnosis and treatment of complex liver tumors, this guideline provides explanations and recommendations in the following aspects: (1) the establishment of homogenization processing and quality control system of 3D reconstruction; (2) the establishment of 3D reconstructed models of abdominal organs and lesions; (3) the individualized classification and quantitative analysis of blood vessels based on 3DVT; (4) 3DVT-based classification and grading of hepatic vessels in complex hepatic tumors; (5) evaluation system for surgery evaluation after reconstruction of the 3D visualization model; (6) application of 3D printing in complex hepatectomy; (7) virtual reality technology; (8) ICG fluorescence imaging; (9) multimodal images for real-time navigation; (10) three-dimensional visualization to guide the preoperative surgical planning of precision hepatectomy; (11) application of 3DVT guidance in other therapeutic methods of hepatocellular carcinoma; (12) application of 3DVT in follow-up evaluation of the patients after liver cancer surgeries. 3DVT for visualization of the liver structures has important clinical values for accurate preoperative evaluation, preoperative planning and surgical navigation of complex liver tumors, and it facilitates precision surgeries to improve the outcomes and promote postoperative recovery of the patients.