三维可视化技术在复杂泡型肝包虫病治疗中的临床应用

doi:10.3877/cma.j.issn.1674-0793.2023.04.004

目的

探讨三维可视化技术在复杂泡型肝包虫病治疗中的临床效果。

方法

收集阿坝藏族羌族自治州人民医院2019年1月至2022年7月收治的复杂泡型肝包虫病67例患者资料，并按照行标准肝包虫病根治术前是否行CT三维重建进行分组。研究组32例，术前利用免费软件行CT重建、模拟肝切除的三维可视化技术精准评估；对照组35例，术前进行CT二维增强扫描。比较两组患者的基线资料、围手术期相关指标、术后并发症发生情况，通过自制问卷调查术中情况与术前CT阅片满意度方面和医患沟通满意度。

结果

两组患者手术顺利，无围手术期死亡病例。研究组和对照组手术方式中转情况比较，差异有统计学意义（0 vs 14.29%，χ²=4.940，P=0.026）。研究组的手术时间、术中出血量和术后住院时间较对照组明显减少（均P<0.05）。两组术后肺部感染、胸腔积液并发症均较多，研究组术后胆漏发生率低于对照组（0 vs 14.29%，χ²=4.940，P=0.026）。研究组术中情况与术前CT阅片满意度评分为（94.22±3.39）分，显著高于对照组的（88.14±3.66）分，医患沟通满意度评分为（87.34±4.40）分，显著高于对照组的（80.71±5.02）分，差异均有统计学意义（t=-7.038、-5.726，均P<0.001）。

结论

三维可视化技术应用于复杂泡型肝包虫病的治疗，有利于制定更符合临床实际的手术方案，明显提高了医患沟通满意度，减少了手术时间、术中出血量和术后住院时间，满足临床需要，值得推广。

关键词: 肝包虫病, 肝切除, 三维可视化技术

Objective

To investigate the effect of three-dimensional visualization technology in the treatment of complex hepatic echinococcosis.

Methods

The data of 67 cases with complex hepatic echinococcosis undergoing standard radical resection in the People’s Hospital of Aba Tibetan and Qiang Autonomous Prefecture from January 2019 to July 2022 were collected. The patients were divided into two groups according to whether CT three-dimensional reconstruction was performed before surgery: 32 cases in the study group were accurately evaluated using CT reconstruction and 3D visualization technology of simulated liver resection; 35 cases in the control group received CT 2D enhanced scanning before operation. Baseline data, perioperative indicators, and incidence of postoperative complications were compared between the two groups. The satisfaction of intraoperative condition and preoperative CT film reading and doctor-patient communication were investigated with questionnaire survey in the two groups.

Results

The operation was successful in both groups, and there were no perioperative deaths. There was significant difference in the conversion of surgical methods between the study group and the control group (0 vs 14.29%, χ²=4.940, P=0.026). The operation time, intraoperative bleeding and postoperative hospital stay in the study group were significantly reduced compared with the control group (all P<0.05). There were complications of pulmonary infection and pleural effusion in both groups, and the incidence of postoperative bile leakage in the study group was lower than that in the control group (0 vs 14.29%, χ²=4.940, P=0.026). The score of satisfaction with intraoperative condition and preoperative CT film reading in the study group was (94.22±3.39), significantly higher than (88.14±3.66) in the control group, the score of doctor-patient communication satisfaction in the study group was (87.34±4.40), significantly higher than (80.71±5.02) in the control group, and the differences were statistically significant (t=-7.038, -5.726, both P<0.001).

Conclusion

Three-dimensional visualization technology in the treatment of complex hepatic echinococcosis is helpful for operation decision-making, significantly improves the satisfaction of doctor-patient communication, reduces the operation time, intraoperative bleeding and postoperative hospitalization stay, and is worthy of clinical promotion.

Key words: Hepatic hydatidosis, Hepatectomy, Three-dimensional visualization technology

表1 两组复杂泡型肝包虫病患者的基线资料比较

项目	研究组	对照组	统计值	P值
例数	32	35
性别(例)			0.464	0.495
男	12(37.50)	16(45.71)
女	20(62.50)	19(54.29)
年龄(岁)^a	40.71±11.80	41.56±12.55	-0.285	0.776
合并高血压(例)	4(12.50)	6(17.14)	0.284	0.594
合并糖尿病(例)	2(6.25)	3(8.57)	0.130	0.718
血红蛋白(g/L)^a	142.13±11.75	144.71±10.94	0.934	0.354
谷氨酸转氨酶(U/L)^a	40.11±5.73	38.69±3.12	1.244	0.218
总胆红素(μmol/L)^a	17.37±2.84	17.47±4.18	-0.112	0.911
白蛋白(g/L)^a	38.06±2.30	37.59±2.43	0.801	0.426
病灶直径(cm)^a	9.80±0.73	9.92±0.76	0.624	0.535
病灶位置(例)
左半肝	15(46.88)	17(48.57)	0.019	0.890
右半肝	12(37.50)	14(40.00)	0.044	0.834
肝三叶	5(15.62)	4(11.43)	0.253	0.615
分型(例)			0.276	0.600
P3/4N0/1M0	28(87.50)	32(91.43)
P3/4N0/1M1	4(12.50)	3(8.57)

表1 两组复杂泡型肝包虫病患者的基线资料比较

项目	研究组	对照组	统计值	P值
例数	32	35
性别(例)			0.464	0.495
男	12(37.50)	16(45.71)
女	20(62.50)	19(54.29)
年龄(岁)^a	40.71±11.80	41.56±12.55	-0.285	0.776
合并高血压(例)	4(12.50)	6(17.14)	0.284	0.594
合并糖尿病(例)	2(6.25)	3(8.57)	0.130	0.718
血红蛋白(g/L)^a	142.13±11.75	144.71±10.94	0.934	0.354
谷氨酸转氨酶(U/L)^a	40.11±5.73	38.69±3.12	1.244	0.218
总胆红素(μmol/L)^a	17.37±2.84	17.47±4.18	-0.112	0.911
白蛋白(g/L)^a	38.06±2.30	37.59±2.43	0.801	0.426
病灶直径(cm)^a	9.80±0.73	9.92±0.76	0.624	0.535
病灶位置(例)
左半肝	15(46.88)	17(48.57)	0.019	0.890
右半肝	12(37.50)	14(40.00)	0.044	0.834
肝三叶	5(15.62)	4(11.43)	0.253	0.615
分型(例)			0.276	0.600
P3/4N0/1M0	28(87.50)	32(91.43)
P3/4N0/1M1	4(12.50)	3(8.57)

图1 术前CT及三维可视化模型　CT示肝包虫病灶巨大，门静脉左支受侵、右支不显影（A）；中肝静脉受侵（B）；门静脉左支受侵、左肝内肝管扩张（C）；3D模型示包虫病灶巨大，完全包裹第一肝门（D）；中肝静脉受侵、右肝静脉消失（E）；下腔静脉受侵或受压变形（F）；门静脉主干及左支受侵、右支不显影（G）；左肝管及左肝Ⅳ段胆管根部受侵狭窄、左肝内胆管扩张（H）；模拟肝切除、计算残肝体积（I）

图2 手术步骤　探查包虫病灶（A）；解剖第一肝门（B）；病灶严重侵蚀第一肝门，劈开部分肝脏后，无法进一步分离解剖第一肝门（C）；切除病灶及侵蚀的门静脉和胆管，进行门静脉重建（D）；切除后情况，拟行胆肠吻合（E）

表2 两组复杂泡型肝包虫病围手术期数据比较

观察指标	研究组	对照组	统计值	P值
例数	32	35
手术方式中转	0(0)	5(14.29)	4.940	0.026^b
胆肠吻合	0(0)	2(5.71)
胆管吻合+T管引流	0(0)	1(2.86)
门静脉重建	0(0)	1(2.86)
肝静脉重建	0(0)	1(2.86)
手术时间(min)^a	244.69±28.11	263.57±24.93	2.914	0.005^b
术中出血量(ml)^a	487.50±143.12	571.43±135.74	2.463	0.016^b
并发症
肺部感染	25(78.12)	28(80.00)	0.036	0.850^b
胸腔积液	19(59.38)	22(62.86)	0.085	0.770^b
胆漏	0(0)	5(14.29)	4.940	0.026^b
术区积液	11(34.38)	15(42.86)	0.506	0.477^b
术后住院时间(d)^a	10.56±1.27	11.80±1.84	3.171	0.002^b
术中情况与术前阅片满意度(分)^a	94.22±3.39	88.14±3.66	-7.038	<0.001^b
医患沟通满意度(分)^a	87.34±4.40	80.71±5.02	-5.726	<0.001^b

表2 两组复杂泡型肝包虫病围手术期数据比较

观察指标	研究组	对照组	统计值	P值
例数	32	35
手术方式中转	0(0)	5(14.29)	4.940	0.026^b
胆肠吻合	0(0)	2(5.71)
胆管吻合+T管引流	0(0)	1(2.86)
门静脉重建	0(0)	1(2.86)
肝静脉重建	0(0)	1(2.86)
手术时间(min)^a	244.69±28.11	263.57±24.93	2.914	0.005^b
术中出血量(ml)^a	487.50±143.12	571.43±135.74	2.463	0.016^b
并发症
肺部感染	25(78.12)	28(80.00)	0.036	0.850^b
胸腔积液	19(59.38)	22(62.86)	0.085	0.770^b
胆漏	0(0)	5(14.29)	4.940	0.026^b
术区积液	11(34.38)	15(42.86)	0.506	0.477^b
术后住院时间(d)^a	10.56±1.27	11.80±1.84	3.171	0.002^b
术中情况与术前阅片满意度(分)^a	94.22±3.39	88.14±3.66	-7.038	<0.001^b
医患沟通满意度(分)^a	87.34±4.40	80.71±5.02	-5.726	<0.001^b

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Application of three-dimensional visualization technology in the treatment of complex hepatic echinococcosis

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Application of three-dimensional visualization technology in the treatment of complex hepatic echinococcosis