三维可视化技术在Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌计划性肝切除中的应用

Abstract
Figure/Table
References
Related Citation (7)

Download: PDF (1424 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To explore the applicability of three-dimensional visualization technology in the planned hepatectomy of type Ⅲ and Ⅳ hilar cholangiocarcinoma. Methods The clinical data of thirty-six patients with type Ⅲ and Ⅳ hilar cholangiocarcinoma treated between January 2015 and December 2017 in the Department of Hepatobiliary Surgery was retrospectively analyzed. Three-dimensional visualization technology was used to reconstruct the 320 slice spiral 2D CT image of patients. By observing the location and size of the tumors and finding out about the relationship between the tumors and the peripheral portal vein, hepatic artery, hepatic vein and intrahepatic bile duct, the resectability of the tumors was assessed. Planned hepatectomy was proposed if the ratio of the residual liver volume was less than 40%. The volume of the residual liver was regenerated via portal vein embolization and biliary drainage. After 2 or 3 weeks, 3D visual reconstruction was performed a second time. Once the ratio of the residual liver volume was more than 40%, radical hepatectomy was carried out as planned. The difference between simulated surgery and actual surgery was studied. Results Three-dimensional visual reconstruction technology was used to display the relationship between the tumors and their surrounding tissues. Bismuth-Corlette classification suggested that there were 16 cases of ⅢA, 8 cases of ⅢB and 12 cases of Ⅳ. The average volume was (1386±146) ml for whole livers,(76±22) ml for tumors,(896±168) ml for the pre-resected liver, and (490±172) ml for residual livers. The ratio of the residual liver volume (34.5%±3.6%) was measured. When the ratio of the residual liver volume exceeded 40% after embolization of the portal vein on the healthy side of biliary drainage, radical resection of hilar cholangiocarcinoma was performed. The accuracy of three-dimensional reconstruction was 100%. The anatomic relationship of the reconstruction model was consistent with what was observed in the course of surgery. There was no significant difference between the volume of the pre-resected liver and the actual volume of the postoperative liver (t=1.148). Conclusions 3D visualization technology can accurately assess hilar cholangiocarcinoma before operation, optimize the treatment plan and improve the R0 resection rate.

Key words： cholangiocarcinoma clinical classification three-dimensional reconstruction resectability planned hepatectomy

Received: 20 October 2020

ZTFLH:	R735.8
	R657.4

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	WEN Zhijian
	CHEN Zhan
	YAN Xingzhou
	YANG Pinghua
	LIN Qian
	LIU lijun
	ZHANG Baohua

Cite this article:

WEN Zhijian,CHEN Zhan,YAN Xingzhou等. Application of three-dimensional visualization technology to planned hepatectomy of type Ⅲ and Ⅳ hilar cholangiocarcinoma[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(3): 218-223.

URL:

http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2021/V32/I3/218

[1]	Mansour J C,Aloia T A,Crane C H, et al. Hilar cholangiocarcinoma: expert consensus statement[J]. HPB,2015, 17(8): 691-699.
[2]	Ramia J M. Hilar cholangiocarcinoma[J]. World J Gastrointest Oncol, 2013, 5(7): 113-114.
[3]	中华医学会数字医学分会, 中国研究型医院学会数字医学临床外科专业委员会. 肝门部胆管癌三维可视化精准诊治专家共识[J]. 中国实用外科杂志, 2017, 37(1): 48-52.
[4]	Anderson B, Doyle M B M. Surgical considerations of hilar cholangiocarcinoma[J]. Surg Oncol Clin N Am,2019, 28(4): 601-617.
[5]	孙健. 联合门静脉及下腔静脉重建整块切除右三叶及尾状叶治疗Ⅳ型肝门部胆管癌[J]. 中华外科杂志, 2019, 57(1): 49-50.
[6]	王冬冬,鲁正,吴维, 等. 扩大肝切除治疗Ⅲ、Ⅳ型肝门部胆管癌[J]. 中华肝胆外科杂志, 2018, 24(11): 761-765.
[7]	敖建阳, 姜小清. 计划性肝切除在肝门部胆管癌中的理论和实践[J]. 肝胆胰外科杂志, 2019, 31(10): 580-582.
[8]	易滨, 姜小清. 肝门部胆管癌的计划性肝切除[J]. 中国普外基础与临床杂志, 2011, 18(6): 576-578.
[9]	梁廷波, 白雪莉. 肝门部胆管癌多学科团队的诊断与治疗[J]. 中华消化外科杂志, 2015, 14(4): 268-274.
[10]	Toumi N,Abid H,Henchir S, et al. Role of magnetic resonance imaging in preoperative assessement of hilar cholangiocarcinoma[J]. Presse Med, 2018, 47(11-12 Pt 1): 950-960.
[11]	Zhang J,Qiao Q L,Guo X C, et al. Application of three-dimensional visualization technique in preoperative planning of progressive hilar cholangiocarcinoma[J]. Am J Transl Res, 2018, 10(6): 1730-1735.
[12]	中国抗癌协会. 肝门部胆管癌规范化诊治专家共识(2015) [J]. 中华肝胆外科杂志, 2015, 21(8): 505-511.
[13]	夏兆云,徐荣泰. 肝门段胆管癌术前影像学评估研究进展[J]. 武警医学, 2017, 28(11): 1175-1178.
[14]	林科灿,曾永毅,黎蕴通, 等. 三维重建虚拟手术规划在肝门部胆管癌手术中的应用价值[J]. 中华消化外科杂志, 2018, 17(4): 383-388.
[15]	Endo I,Shimada H,Sugita M, et al. Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma[J]. Surgery, 2007, 142(5): 666-675.
[16]	鲁正,王冬冬.2型肝门部胆管癌的手术治疗方式[J]. 中华外科杂志, 2016, 54(7): 488-491.
[17]	鲁正, 王冬冬. Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌的手术治疗方式[J]. 中华外科杂志, 2016, 54(7): 488-491.
[18]	张大伟,李海燕,蒋小峰, 等. Ⅲ、Ⅳ型肝门部胆管癌局限性切除和扩大肝切除疗效比较[J]. 中华肝脏外科手术学电子杂志, 2019, 8(1): 35-38.
[19]	Poruk K E,Pawlik T M, Weiss M J. Perioperative management of hilar cholangiocarcinoma[J]. J Gastrointest Surg, 2015, 19(10): 1889-1899.
[20]	张隽,乔岐禄,吴问汉, 等. 术前经皮经肝胆道穿刺引流及门静脉栓塞联合扩大肝切除术治疗局部进展期肝门部胆管癌[J]. 中华肝胆外科杂志, 2017, 23(3): 173-175.
[21]	文张,徐邦浩,王继龙, 等. 肝动脉戴戒限流术联合肝脏分隔和门静脉结扎的二步肝切除术治疗巨块型肝癌的临床疗效[J]. 中华消化外科杂志, 2019, 18(5): 489-498.
[22]	李健,文张,徐邦浩, 等. 联合门静脉切除重建的ALPPS治疗肝内胆管细胞癌[J]. 中华肝脏外科手术学电子杂志, 2020, 9(1): 62-66.
[23]	洪德飞,沈国樑,张远标, 等. 经皮微波消融肝实质分隔联合门静脉栓塞计划性肝切除治疗肝门部胆管癌[J]. 中华普通外科杂志, 2016, 31(9): 750-753.