计算机辅助手术系统在精准肝切除手术中的指导意义

The Guiding Significance of Computer-Assisted Surgery System in Precise Hepatectomy

摘要: 目的：分析计算机辅助手术系统在精准肝切除手术中的指导意义。方法：回顾性分析2017~2019年行肝切除术的肝细胞肝癌患者共233例，233例患者术前均行上腹部动态增强CT，其中126例利用计算机辅助手术系统(Hisense CAS)将增强CT图像进行三维重建，根据三维重建结果规划最佳手术方案，根据术前方案行针对性肝段精准切除术，作为实验组；其余107例未行CAS三维重建的患者行传统肝段切除术，作为对照组，分析两组之间手术时间、术中出血量、正常肝体积损失率(切除肝组织中正常肝组织体积占比)、术后并发症等。对手术时间、术中出血量、正常肝体积损失率等分析采用t检验，对率的分析采用χ2检验。结果：实验组术中出血量(142.60 ± 98.445) ml，手术时间(145.16 ± 51.36) min，术后住院时间(5.11 ± 1.101)天，正常肝组织损失率(16.17 ± 4.91)%；对照组(215.47 ± 159.80) ml，手术时间(178.73 ± 59.44) min，术后住院时间(5.66 ± 1.03)天，正常肝组织损失率为(33.22 ± 4.98)%；实验组各项指标明显低于对照组(t = −3.16, −3.55, −3.14, −7.21, P < 0.05)。实验组术后1例出现胆瘘，1例出现低蛋白血症，对照组术后3例患者出现胆瘘，4例出现低蛋白血症，2例出血。两组差异存在统计学意义(χ2 = 4.227, P < 0.05)。所有患者术后均治愈出院，术后随访半年肿瘤均未复发。结论：计算机辅助手术系统可在术前对患者肝脏进行精确重建，明确肿瘤与周围血管、组织的关系，为手术提供精准指导，减小患者手术损伤，改善预后。

Abstract: Objective: To analyze the guiding significance of computer-assisted surgery system in precision liver resection. Methods: A total of 233 patients with hepatocellular carcinoma who underwent hepatectomy from 2017 to 2019 were retrospectively analyzed. All 233 patients underwent dynamic enhanced CT of the upper abdomen before surgery, and as the experimental group,126 of them used the computer-assisted surgery system (Hisense CAS) to enhance the CT images. Carrying out three-dimensional reconstruction, the best surgical was planned based on the results of the three-dimensional reconstruction, and the targeted precision hepatectomy was performed based on the preoperative plan. The remaining 107 patients without CAS three-dimensional reconstruction underwent traditional hepatectomy as a control group. The operation time, intraoperative blood loss, normal liver volume loss rate (the proportion of normal liver tissue volume in the resected liver tissue), postoperative complications, etc. were analyzed between the two groups. The t test was used to analyze the operation time, intraoperative blood loss, and the rate of normal liver volume loss, and the χ2 test was used to analyze the rate. Result: In the experimental group, intraoperative blood loss (142.60 ± 98.445) ml, operation time (145.16 ± 51.36) min, postoperative hospital stay (5.11 ± 1.101) days, normal liver tissue loss rate (16.17 ± 4.91)%; control group (215.47 ± 159.80) ml, operation time (178.73 ± 59.44) min, postoperative hospital stay (5.66 ± 1.03) days, normal liver tissue loss rate was (33.22 ± 4.98)%; various indicators of the experimental group were significantly lower than those of the control group (t = −3.16, −3.55, −3.14, −7.21, P < 0.05). In the experimental group, 1 patient developed biliary fistula and 1 patient developed hypoproteinemia. In the control group, 3 patients developed biliary fistula, 4 patients developed hypoproteinemia, and 2 patients had hemorrhage. The difference between the two groups was statistically significant (χ2 = 4.227, P < 0.05). All patients were cured and discharged after the operation, and no tumor recurred during follow-up for half a year. Conclusion: The computer-assisted surgery system can accurately reconstruct the patient’s liver before surgery, clarify the relationship between the tumor and the surrounding blood vessels and tissues, provide precise guidance for surgery, reduce surgical damage, and improve the prognosis.