三维可视化在原发性肝癌治疗中的作用及应用

X. Hao, C. Jiajia
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摘要

原发性肝癌是指肝脏恶性肿瘤。肝细胞癌占原发性肝癌的90%以上,其发病率在全球肿瘤发病率中排名第六,死亡率在肿瘤相关死亡中排名第三。手术切除是早期原发性肝癌的首选治疗方法。根据米兰标准、美国加州大学标准和杭州标准,包括肝移植、肝部分切除术、腹腔镜肝切除术等。但如何进行手术取决于手术前不同阶段的肿瘤评估。医学影像学是评估恶性程度的方法,但通常是二维的。尽管高端的CT和MR可以重建三维图像,但临床医生仍然只能看到二维图像。因此,为了诊断疾病,外科医生必须根据自己的经验和肝脏解剖结构,在脑海中将二维图像重建为三维图像,这可能会导致治疗的不确定性和错误[1]。在以下情况下更是如此:复杂的肝切除术,需要切除更大的肝组织,可能导致术后肝功能紊乱甚至肝功能衰竭;特殊手术部位靠近大血管,解剖位置不易暴露,易引起术中出血;肝血供紊乱(肝充血、肝缺血)增加手术难度和风险。所有这些都需要临床医生制定充分的术前计划,仔细的术中解剖和适当的术后管理bbb。
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The Function and Application of 3D Visualization in the Treatment of Primary Hepatic Carcinoma
Primary Hepatic Carcinoma refers to malignant liver tumors. Hepatocellular Carcinoma accounts for more than 90% of primary hepatic carcinomawith its incidence rate ranking the sixth in global tumor incidence and mortality rate ranking the third in tumor-related death in the world. Surgical resection is the preferred treatment for early primary hepatic carcinoma. It includes liver transplantation, partial hepatectomy, laparoscopic hepatectomy, etc. based on Milan criteria, University of California criteria and Hang Zhou criteria. But how the operation is done relies on tumor-evaluation in different stages before the surgery. Medical Imaging is the way to evaluate malignancy degree but is usually 2D. Even though the high-end CT and MR can reconstruct 3D image, clinicians are still provided with 2D image. Therefore, in order to diagnose diseases, surgeons have to reconstruct 2D image into 3D image in their mind according to their experience and liver anatomical structure, causing possible uncertainty and errors in the treatment [1]. It is more so in the following cases: complicated hepatectomy, which requires to resect a larger part of liver tissue, may give rise to postoperative hepatic disorder or even hepatic failure; special surgery site makes it hard to expose the anatomical position and may cause intraoperative bleeding because it is close to major vessels; hepatic blood supply disorder (hepatic congestion, hepatic ischemia) increases difficulty and risk in surgery. All of the above require clinicians to make sufficient preoperative plans, careful intraoperative anatomy and proper postoperative management [2].
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