摘要
目的探讨三维重建及全量化技术在肝门部胆管癌根治术中的应用。方法回顾性分析40例肝门部胆管癌(hilar cholangiocarcinoma,HCCA)患者的临床资料,按影响评估方法不同分为重建组(20例)和对照组(20例)。重建组通过三维重建技术评估肿瘤Bismuth-Corlette分型及血管变异,对照组行常规CT检查后进行评估。比较2组患者术前、术中、术后相关指标。结果重建组评估门静脉的准确性、特异度、灵敏度依次是80.0%、84.6%、71.4%;评估肝动脉的准确性、特异度、灵敏度依次是80.0%、85.7%、66.7%。重建组腹腔引流管全部拔除时间(9.95±2.04)d低于对照组(14.30±3.11)d(P<0.05);术后第3、7天重建组总胆红素(54.50±45.31)μmol·L^(-1)、(36.55±34.34)μmol·L^(-1)低于对照组(85.27±47.37)μmol·L^(-1)、(57.50±27.56)μmol·L^(-1)(P<0.05);术后第1天、3天重建组白蛋白浓度(34.35±4.70)g·L^(-1)、(38.46±7.83)g·L^(-1)高于对照组(31.02±3.08)g·L^(-1)、(33.80±6.03)g·L^(-1)(P<0.05)。重建组术后胆漏和术后出血各1例;对照组术后2例胆漏,1例出血;重建组术后总并发症发生率为10%(2/20),对照组术后总并发症发生率为15%(3/20)。结论三维重建及全量化技术可为肝门部胆管癌患者Bismuth-Corlette分型提供更可靠的依据,辅助外科医师精准评估;同时能更准确识别肝门部脉管变异,为术中解剖变异提供预案,从而节省手术时间、降低术中出血、缩短住院时间、促进术后肝功能恢复。
Objective To explore the application of three-dimensional reconstruction and full quantification in radical resection of hilar cholangiocarcinoma.Methods The clinical data of 40 patients with hilar cholangiocarcinoma(HCCA)were retrospectively analyzed.The patients were divided into reconstruction group(20 cases)and control group(20 cases)according to different impact assessment methods.The Bismuth-Corlette classification and vascular variation of the tumor were evaluated by three-dimensional reconstruction technique in the reconstruction group,and the control group was evaluated after routine CT examination.The preoperative,intraoperative and postoperative related indexes were compared between the two groups.Results The accuracy,specificity and sensitivity of portal vein reconstruction were 80.0%,84.6%and 71.4%,respectively.The accuracy,specificity and sensitivity of the evaluation of hepatic artery were 80.0%,85.7%and 66.7%,respectively.The total removal time of abdominal drainage tube in the reconstruction group(9.95±2.04)d was lower than that in the control group(14.30±3.11)d(P<0.05).The total bilirubin(54.50±45.31)μmol·L^(-1)and(36.55±34.34)μmol·L^(-1)in the reconstruction group were lower than those in the control group(85.27±47.37)μmol·L^(-1)and(57.50±27.56)μmol·L^(-1)on the 3 rd and 7 th day after operation(P<0.05).The albumin concentration of the reconstruction group was(34.35±4.70)g·L^(-1)and(38.46±7.83)g·L^(-1)higher than that of the control group(31.02±3.08)g·L^(-1)and(33.80±6.03)g·L^(-1)on the 1 st and 3 rd day after operation(P<0.05).There were 1 case of postoperative bile leakage and 1 case of postoperative bleeding in the reconstruction group.In the control group,there were 2 cases of bile leakage and 1 case of bleeding after operation.The total incidence of postoperative complications was 10%(2/20)in the reconstruction group and 15%(3/20)in the control group.Conclusion Three-dimensional reconstruction and full quantification technology can provide a more reliable basis for Bismuth-Corlette classification in patients with hilar cholangiocarcinoma,and assist surgeons in accurate evaluation.At the same time,it can more accurately identify the variation of hepatic portal vessels and provide a plan for intraoperative anatomical variation,so as to save operation time,reduce intraoperative bleeding,shorten hospitalization time and promote postoperative liver function recovery.
作者
崔择颖
孙中帅
李涛
崔大鹏
CUI Ze-ying;SUN Zhong-shuai;LI Tao;CUI Da-peng(Graduate School,Hebei North University,Zhangjiakou,Hebei 075000,China;General Surgery Department,The First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)
出处
《河北北方学院学报(自然科学版)》
2026年第2期1-9,共9页
Journal of Hebei North University(Natural Science Edition)
基金
2022年河北省科技计划项目(No.223777101D)。
关键词
肝门部胆管癌
三维重建及全量化技术
腹腔镜手术
术前评估
Hilar cholangiocarcinoma
Three-dimensional reconstruction and full quantization technology
Laparoscopic surgery
Preoperative evaluation
