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目的:探讨三维重建技术在肝门部胆管癌术前评估中的应用价值。方法:收集34例行联合肝切除肝门部胆管癌切除术患者的临床资料,其中15例术前行三维规划(观察组),19例未行三维规划(对照组),比较两组患者的相关手术指标;分析观察组依据三维重建确定的肿瘤分型与实际手术结果的相符度,以及二维及三维图像对肝体积评估的差异。结果:观察组平均术中出血量(525.4 m L vs.676.3 m L)、手术时间(5.0 h vs.5.8 h)、拔管时间(8.9 d vs.11.4 d)均较对照组明显减少(P=0.014、P=0.020、P=0.037),但两组术后住院时间和术后总并发症发生率差异无统计学意义(均P>0.05)。观察组患者根据重建结果对肿瘤进行BismuthCorlette分型与实际结果比较符合度为86.7%(13/15);术前二维与三维计算出的平均肝切除体积差异无统计学意义(404.9 m L vs.411.2 m L,P>0.05)。结论:三维重建可以完成对肝门部胆管癌的术前精确评估,对肝门部胆管癌手术治疗有一定的指导意义。
Objective: To investigate the value of three-dimensional reconstruction in the preoperative evaluation of hilar cholangiocarcinoma. Methods: The clinical data of 34 patients undergoing hepatectomy and resection of hilar cholangiocarcinoma were collected. Among them, 15 patients underwent three-dimensional planning (observation group) and 19 patients underwent three-dimensional planning (control group) The surgical indexes were analyzed. The coincidence of tumor type and actual surgical result determined by three-dimensional reconstruction in observation group and the difference of two-dimensional and three-dimensional images on liver volume were analyzed. Results: The mean intraoperative blood loss (525.4 m L vs. 676.3 m L), operation time (5.0 h vs. 5.5 h) and extubation time (8.9 d vs.11.4 d) were significantly lower in the observation group than in the control group (P = 0.014, P = 0.020, P = 0.037). However, there was no significant difference in postoperative hospital stay and postoperative complications between the two groups (all P> 0.05). In the observation group, BismuthCorlette classification based on the reconstruction results was 86.7% (13/15) compared with the actual results. There was no significant difference in the average volume of hepatic resection between preoperative 2D and 3D (404.9 m L vs .411.2 m L, P> 0.05). Conclusion: Three-dimensional reconstruction can complete the preoperative accurate assessment of hilar cholangiocarcinoma and has some guiding significance for the surgical treatment of hilar cholangiocarcinoma.