基于三维可视化技术指导肝多房棘球蚴病手术方案的应用研究

doi:10.12140/j.issn.1000-7423.2024.06.007

中国寄生虫学与寄生虫病杂志 ›› 2024, Vol. 42 ›› Issue (6): 737-743.doi: 10.12140/j.issn.1000-7423.2024.06.007

基于三维可视化技术指导肝多房棘球蚴病手术方案的应用研究

李振伟(), 王成, 王志鑫, 刘津铭, 赵乾, 王海久, 谢智^*()

青海大学附属医院肝胆胰外科，青海西宁 810000

收稿日期:2024-08-22 修回日期:2024-10-12 出版日期:2024-12-30 发布日期:2025-01-14
通讯作者: *谢智（1987—），男，硕士，副主任医师，从事肝胆胰外科数字化及3D打印研究。E-mail：13997217508@163.com
作者简介:李振伟（1988—），男，硕士，主治医师，从事肝胆胰外科数字化及3D打印研究。E-mail：918124719@qq.com
基金资助:
2023年度青海大学青年科研基金(2023-QYY-4);青海省卫生健康委员会(Qingwei Health Office [2023] 125);青海省科学技术厅(Qingkefa Regulations [2022] 84)

Research on the application of 3D visualization-based technology to guide surgical plan for hepatic alveolar echinococcosis

LI Zhenwei(), WANG Cheng, WANG Zhixin, LIU Jinming, ZHAO Qian, WANG Haijiu, XIE Zhi^*()

Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Qinghai University, Xining 810000, Qinghai, China

Received:2024-08-22 Revised:2024-10-12 Online:2024-12-30 Published:2025-01-14
Contact: *E-mail: 13997217508@163.com
Supported by:
2023 Youth Research Fund Project of Qinghai University(2023-QYY-4);Qinghai Provincial Health Commission(Qingwei Health Office [2023] 125);Department of Science and Technology of Qinghai Province(Qingkefa Regulations [2022] 84)

摘要/Abstract

摘要：

目的探索三维可视化技术在辅助设计针对肝多房棘球蚴病手术治疗方案中的创新性应用。方法选取2020年1月—2023年3月在青海大学附属医院术前行三维可视化技术的50例肝多房棘球蚴病患者作为研究对象，将患者原始数据传输至人体三维可视化虚拟手术系统，通过三维可视化重建测定全肝体积、预切肝体积、预留肝体积以及棘球蚴病灶体积，计算残肝比，对比术中实际所见，评估三维可视化技术对肝多房棘球蚴病的应用价值。另选择同期未行三维可视化技术的50例肝多房棘球蚴病患者作为对照组，对照组采用二维增强CT影像 + 精准肝切除。比较两组一般资料及围术期资料，采用广义估计方程模型（GEE）分析患者术后预后的影响因素。结果两组患者在年龄、性别、体质量指数（BMI）、切除部位、病灶直径、切除肝脏体积、剩余肝脏体积等一般资料，以及在CT特征及MRI等影像学资料的差异均无统计学意义（P > 0.05）。与对照组相比，研究组患者手术时间[（228.56 ± 29.47）min]、Pringle法全肝阻断时间[（26.65 ± 4.78）min]更短，术中出血量[（435.14 ± 98.76）ml]更少，住院时间[（15.27 ± 2.13）d]更短，住院费用[（4.58 ± 0.79）万元]更低，医患沟通满意度（89.65 ± 9.23）更高（t = 3.856、3.561、6.069、3.561、5.400、3.812，均P < 0.05）。重建的三维模型可进行旋转、缩放、平移等操作，还可以隐藏或者半透明化肝实质、静脉、动脉等结构，可清晰、直观地了解肝脏各重要解剖结构与病灶之间的空间位置关系。三维可视化技术预测的预切肝脏平均体积为2 154.43 ml，预留肝脏平均体积为1 203.27 ml，平均残肝比为41.22%；术中实际切除肝脏平均体积为2 138.75 ml，实际剩余肝脏平均体积为1 193.46 ml。三维可视化重建拟切除肝体积与实际切除肝体积差异无统计学意义（t = 1.135，P > 0.05）。GEE分析结果显示，肝多房棘球蚴边缘浸润带有侵犯和三维可视化重建均显著影响患者预后情况（χ² = 7.890、3.876，P < 0.05）。结论三维可视化技术可用于肝多房棘球蚴病患者术前制定合理的肝脏切除方案，提高手术成功率、改善患者预后。

关键词: 肝多房棘球蚴病, 术前规划, 三维可视化技术, 预后

Abstract:

Objective Exploring the innovative application of 3D visualization technology in assisting the design of surgical treatment plans for hepatic alveolar echinococcosis (HAE). Methods Fifty HAE patients who underwent preoperative examination with 3D visualization technology at the Affiliated Hospital of Qinghai University from January 2020 to March 2023 were enrolled to participate the research. The patient’s raw data was transmitted to a human 3D visualization virtual surgical system to process 3D visual reconstruction modeling for determining the whole liver volume, planned liver resection volume, the liver volume to be reserved, and the hydatid lesion volume, thereby,the residual liver ratio was calculated, and compared with what actually seen in the operation to evaluate the application value of 3D visualization technology for HAE. Another 50 patients with HAE who did not undergo 3D visualization technology during the same period were selected as the control group. The control group received 2D enhanced CT imaging and precise liver resection. Compare the general and perioperative data between the two groups were compared and the generalized estimating equation (GEE) model was used to analyze the influencing factors on patients’ postoperative prognosis. Results There was no statistically significant difference in general information such as age, gender, body mass index (BMI), resection site, lesion diameter, excised liver volume, remaining liver volume, as well as differences in CT features and MRI imaging data between two groups of patients (P > 0.05). Compared with the control group, the study group had shorter surgical time [(228.56 ± 29.47) min], pringle method total liver block time [(26.65 ± 4.78) min], less intraoperative blood loss [(435.14 ± 98.76) ml], shorter hospital stay [(15.27 ± 2.13) days], lower hospitalization costs [(4.58 ± 0.79) yuan], and higher satisfaction with doctor-patient communication (89.65 ± 9.23) (t = 3.856, 3.561, 6.069, 3.561, 5.400, 3.812; all P < 0.05). The reconstructed 3D model can be rotated, scaled, and translated, and can also hide or render semi-transparent structures such as liver parenchyma, veins, and arteries, providing a clear and intuitive understanding of the spatial relationships between important anatomical structures and lesions in the liver. The average volume of planned liver resection predicted by 3D visualization technology is 2 154.43 ml, the average volume of reserved liver is 1 203.27 ml, and the average residual liver ratio is 41.22%. The average volume of liver resection during the operation was 2 138.75 ml, and the average volume of remaining liver was 1 193.46 ml. There was no statistically significant difference (t = 1.135, P > 0.05) between the estimated and actual liver volumes obtained through 3D visualization reconstruction. The GEE analysis results showed that the invasion of hepatic Echinococcus multilocularis edge infiltration and 3D visualization reconstruction significantly affected the prognosis of patients (χ² = 7.890, 3.876; P < 0.05). Conclusion Three dimensional visualization technology can be used to develop a rational liver resection plan for HAE patients before surgery, improving the success rate of surgery and enhancing patients’ prognosis.

Key words: Hepatic alveolar echinococcosis, Preoperative planning, 3D visualization technology, Prognosis

中图分类号:

R532.32

李振伟, 王成, 王志鑫, 刘津铭, 赵乾, 王海久, 谢智. 基于三维可视化技术指导肝多房棘球蚴病手术方案的应用研究[J]. 中国寄生虫学与寄生虫病杂志, 2024, 42(6): 737-743.

LI Zhenwei, WANG Cheng, WANG Zhixin, LIU Jinming, ZHAO Qian, WANG Haijiu, XIE Zhi. Research on the application of 3D visualization-based technology to guide surgical plan for hepatic alveolar echinococcosis[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2024, 42(6): 737-743.

图/表 6

表1

表2

表3

图1

表4

表5

肝多房棘球蚴病患者预后的影响因素分析

项目 Project	β	SE	95% CI		参数估计 Parameter estimation			OR 95% CI
项目 Project	β	SE	上限 Upper limits	下限 Lower limits	Wald χ²	OR	P	上限 Upper limits	下限 Lower limits
肝多房棘球蚴边缘浸润带 Marginal infiltrative zone of hepatic E. multilocularis	0.987	0.456	1.645	0.328	7.890	2.682	0.005	4.756	1.378
切除部位 Removal site	0.123	0.100	0.321	-0.075	1.485	1.130	0.223	1.382	0.885
病灶直径 Diameter of lesion	-0.087	0.098	0.023	-0.197	0.789	0.917	0.375	1.025	0.812
切除肝脏体积 Liver resection volume	0.045	0.067	0.157	-0.067	0.456	1.046	0.500	1.158	0.934
剩余肝脏体积 Remaining liver volume	0.234	0.156	0.545	-0.077	2.345	1.263	0.126	1.645	0.928
手术时间 Surgical duration	0.156	0.145	0.446	0.006	1.456	1.169	0.228	1.678	1.006
出血量 Bleeding volume	-0.567	0.345	-0.078	1.056	6.012	0.568	0.064	0.876	1.324
术后住院时间 Postoperative hospitalization time	0.002	0.045	0.094	-0.090	0.009	1.002	0.925	1.107	0.905
Pringle法全肝阻断时间 Pringle method whole liver block time	-0.012	0.034	0.050	-0.074	0.112	0.988	0.738	1.040	0.934
住院费用 Hospitalization expenses	0.056	0.067	0.189	-0.077	0.632	1.057	0.427	1.221	0.923
分型 Classification	0.023	0.089	0.191	-0.145	0.063	1.023	0.802	1.130	0.889
病灶大小 Disease size	0.012	0.090	0.204	-0.180	0.017	1.012	0.897	1.125	0.890
瘤周强化 Peritumoral enhancement	0.045	0.067	0.177	-0.087	0.456	1.046	0.500	1.155	0.937
边缘表现 Edge performance	-0.023	0.045	0.045	-0.111	0.289	0.977	0.590	1.079	0.876
瘤周低信号 Low signal around the tumor	0.067	0.089	0.245	-0.111	0.587	1.070	0.444	1.287	0.890
强化方式 Strengthening methods	-0.009	0.045	0.037	-0.095	0.041	0.991	0.840	1.033	0.902
增强类型 Enhanced type	0.045	0.089	0.223	-0.137	0.267	1.046	0.605	1.200	0.891
T1WI	1.038	0.423	0.447	1.273	6.023	2.824	0.062	1.564	3.571
T2WI	0.468	0.213	-0.449	0.776	4.817	1.596	0.162	0.638	2.173
三维可视化重建 3D visualization reconstruction	-0.378	0.192	-0.794	-0.122	3.876	0.685	0.025	0.452	0.885

表5

参考文献 17

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项目Project	研究组患者（n = 50） Patients in research group (n = 50)	对照组患者（n = 50） Patients in control group (n = 50)	t/χ²	P
年龄/岁 Age/Year	43.15 ± 4.37	43.23 ± 4.25	0.072	0.943
性别 Gender			0.05	0.823
男 Male	26（52.00%）^a	24（48.00%）^a
女 Female	24（48.00%）^a	26（52.00%）^a
体质量指数/kg•m^-2 BMI/kg•m^-2	23.35 ± 2.98	23.41 ± 3.34	0.02	0.984
肝多房棘球蚴边缘浸润带 Marginal infiltrative zone of hepatic Echinococcus multilocularis			0.363	0.547
有侵犯 Infringement	23（46.00%）^a	24（48.00%）^a
无侵犯 No infringement	27（54.00%）^a	26（52.00%）^a
切除部位 Removal site			1.958	0.581
左半肝切除 Left hemihepatectomy	13（26.00%）^a	14（28.00%）^a
左半肝切除 + 肝门棘球蚴切除 Left hemihepatectomy + hepatic portal echinococcectomy	10（20.00%）^a	13（26.00%）^a
右半肝切除 Right hemihepatectomy	10（20.00%）^a	7（14.00%）^a
右半肝切除 + 肝门棘球蚴切除 Right hemihepatectomy + hepatic portal echinococcectomy	13（26.00%）a	12（24.00%）a
解剖性肝段切除 Anatomical liver segmentectomy	4（8.00%）a	4（8.00%）a
病灶直径/cm Diameter of lesion/cm	8.24 ± 1.16	8.37 ± 1.22	0.001	0.970
切除肝脏体积/ml Liver resection volume/ml	2 138.75 ± 157.94	2 129.42 ± 148.73	0.353	0.725
剩余肝脏体积/ml Remaining liver volume/ml	1 193.46 ± 85.73	1 215.63 ± 91.48	0.125	0.693

项目 Project	研究组例数（占比/%）（n = 50） No. research group case (Proportion/%) (n = 50)	对照组例数（占比/%）（n = 50） No. control group case (Proportion/%) (n = 50)	t/χ²	P
CT特征 CT feature
分型 Classification			0.294	0.770
结节型 Nodular type	16（32.00）	19（38.00）
巨块型 Giant block typae	22（44.00）	20（40.00）
弥漫型 Diffuse type	12（24.00）	11（22.00）
病灶大小/cm Disease size/cm			0.214	0.648
< 5	27（54.00）	25（50.00）
≥ 5	23（46.00）	25（50.00）
瘤周强化 Peritumoral enhancement			0.113	0.739
是 Yes	31（62.00）	29（58.00）
否 No	19（38.00）	21（42.00）
边缘表现 Edge performance			0.321	0.572
光滑 Smooth	14（28.00）	13（26.00）
不光滑 Not smooth	36（72.00）	37（74.00）
瘤周低信号 Low signal around the tumor			0.182	0.671
是 Yes	26（52.00）	22（44.00）
否 No	24（48.00）	28（56.00）
强化方式 Strengthening method			0.328	0.567
典型 Typical	27（54.00）	25（50.00）
不典型 Not typical	23（46.00）	25（50.00）
增强类型 Enhanced type			0.42	0.518
均匀 Uniformity	18（36.00）	16（32.00）
不均匀 Uneven	32（64.00）	34（68.00）
MRI
T1WI			0.625	0.430
稍低信号 Slightly lower signal	13（26.00）	11（22.00）
等信号 Middle signal	20（40.00）	24（48.00）
稍高信号 Slightly high signal	17（34.00）	15（30.00）
T2WI			0.222	0.638
稍低信号 Slightly lower signal	9（18.00）	13（26.00）
等信号 Middle signal	22（44.00）	19（38.00）
稍高信号 Slightly high signal	19（38.00）	18（36.00）

项目 Project	研究组（n = 50） Research group (n = 50)	对照组（n = 50） Control group (n = 50)	t/χ²	P
手术时间/min Surgical duration/min	228.56 ± 29.47	284.32 ± 24.89	3.856	<0.001
出血量/ml Bleeding volume/ml	435.14 ± 98.76	517.45 ± 88.65	6.069	0.014
术后住院时间/d Postoperative hospitalization time/d	15.27 ± 2.13	16.43 ± 2.98	3.561	0.037
Pringle法全肝阻断时间/min Pringle method whole liver block time/min	26.65 ± 4.78	33.98 ± 3.91	5.4	0.023
住院费用/万元 Hospitalization expenses/10 000 yuan	4.58 ± 0.79	4.79 ± 0.92	2.627	0.01
医患沟通满意度 Satisfaction with doctor-patient communication	89.65 ± 9.23	81.50 ± 10.49	3.812	<0.001

项目 Project	研究组患者 Patients in research group
肝脏体积/ml Liver volume/ml	3 354.52 ± 174.96
棘球蚴病灶体积/ml Volume of Echinococcus lesion/ml	6 771.95 ± 365.45
预留肝脏体积/ml Reserved liver volume/ml	1 203.27 ± 98.23
预切肝脏体积/ml Pre cut liver volume/ml	2 154.43 ± 136.52
残肝比 Residual liver ratio/%	41.22 ± 6.38
实际切除肝脏体积/ml Actual volume of liver resection/ml	2 138.75 ± 157.94
实际剩余肝脏体积/ml Actual remaining liver volume/ml	1 193.46 ± 85.73

基于三维可视化技术指导肝多房棘球蚴病手术方案的应用研究

Research on the application of 3D visualization-based technology to guide surgical plan for hepatic alveolar echinococcosis

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[5]	吴亮亮, 杨凌菲, 宋涛. 不同方式建立肝多房棘球蚴感染SD大鼠模型病灶的超声及病理表现[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(4): 549-552.
[6]	喀斯木·艾海提, 阿卜杜萨拉木·艾尼, 吐尔干艾力·阿吉, 邵英梅, 张瑞青, 塔来提·吐尔干, 蒋铁民, 冉博, 阿卜杜艾尼·啊卜力孜, 米尔阿迪力·艾尔肯, 温浩. 离体肝切除和自体肝移植术治疗终末期肝多房棘球蚴病的住院医疗费用分析[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38(1): 53-57.
[7]	张伟娜, 顾伟, 焦建明, 罗娇. 15例片形吸虫病患者临床资料分析[J]. 中国寄生虫学与寄生虫病杂志, 2019, 37(2): 207-212.
[8]	许晓磊, 王志鑫, 王展, 叶海雯, 庞明泉, 周灜, 王海久, 樊海宁. 98例复杂性肝多房棘球蚴病外科治疗方案的比较分析[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(6): 552-559.
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[10]	阿卜杜萨拉木·艾尼1，吐尔洪江·吐逊2，马海长3，张恒2，张皓1，阿卜杜凯尤木·麦麦提4，李玉鹏2，沙地克·阿帕尔2，林仁勇5，邵英梅1，温浩5*. Toll样受体mRNA和相关细胞因子在肝多房棘球蚴病患者体内的变化[J]. 中国寄生虫学与寄生虫病杂志, 2016, 34(6): 12-542-546.