Three-dimensional morphometric analysis for hepatectomy of centrally located hepatocellular carcinoma: A pilot study
Three-dimensional morphometric analysis for hepatectomy of centrally located hepatocellular carcinoma: A pilot study
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DOI：
10.3748/wjg.v21.i15.4607
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发表时间：
2015-04-21
影响因子：
4.3
通讯作者：
Liu, Yun-He
中科院分区：
文献类型：
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作者：
Tian, Fei;Wu, Jian-Xiong;Liu, Yun-He
目的：描述一个三维模型（3DM），以准确地重建位于中心的肝细胞癌（HCC）的解剖关系。方法：从2013年3月至2014年7月，在39例患者中，使用基于对象的计算机断层扫描（CT）模型与定制开发的软件进行重建和可视化模拟位于中心的HCC。CT图像用于Couinaud的蒂和肝静脉的三维重建，并使用Yorktal DMIT软件进行相应的肿瘤区域和肝段的计算。术前用该模型估计肿瘤的体积、手术切缘和模拟虚拟切除。所有患者均接受手术治疗，并对结果进行回顾性评估。临床特征，影像学数据，程序变量，病理特征，术后数据进行记录和比较，以确定模型的可靠性。结果：三维重建允许立体识别的生理和病理结构之间的空间关系，并提供量化的肝切除建议的基础上个性化的肝脏解剖。肿瘤体积的预测值与实际值一致（82.4 ± 109.1 mL vs 84.1 ± 108.9 mL，P = 0.910），手术切缘（10.1 ± 6.2 mm vs 9.1 ± 5.9 mm，P = 0.488）和最大肿瘤直径（4.61 ± 2.16 cm vs 4.53 ± 2.14 cm，P = 0.871）。此外，门静脉分支的数量和范围，以及它们与肝静脉的关系，是可视化的。基于模拟切除的术前计划有助于完全切除位于主要血管汇合处的大肿瘤。大部分的预测数据与术中发现。结论：这3DM提供了定量的肿瘤肿块的形态计量学和与邻近结构的立体关系，从而提供了一个有前途的技术，为中央位于HCC的管理。
AIM: To describe a three-dimensional model (3DM) to accurately reconstruct anatomic relationships of centrally located hepatocellular carcinomas (HCCs).METHODS: From March 2013 to July 2014, reconstructions and visual simulations of centrally located HCCs were performed in 39 patients using a 3D subject-based computed tomography (CT) model with custom-developed software. CT images were used for the 3D reconstruction of Couinaud's pedicles and hepatic veins, and the calculation of corresponding tumor territories and hepatic segments was performed using Yorktal DMIT software. The respective volume, surgical margin, and simulated virtual resection of tumors were also estimated by this model preoperatively. All patients were treated surgically and the results were retrospectively assessed. Clinical characteristics, imaging data, procedure variables, pathologic features, and postoperative data were recorded and compared to determine the reliability of the model.RESULTS: 3D reconstruction allowed stereoscopic identification of the spatial relationships between physiologic and pathologic structures, and offered quantifiable liver resection proposals based on individualized liver anatomy. The predicted values were consistent with the actual values for tumor mass volume (82.4 +/- 109.1 mL vs 84.1 +/- 108.9 mL, P = 0.910), surgical margin (10.1 +/- 6.2 mm vs 9.1 +/- 5.9 mm, P = 0.488), and maximum tumor diameter (4.61 +/- 2.16 cm vs 4.53 +/- 2.14 cm, P = 0.871). In addition, the number and extent of portal venous ramifications, as well as their relation to hepatic veins, were visualized. Preoperative planning based on simulated resection facilitated complete resection of large tumors located in the confluence of major vessels. And most of the predicted data were correlated with intraoperative findings.CONCLUSION: This 3DM provides quantitative morphometry of tumor masses and a stereo-relationship with adjacent structures, thus providing a promising technique for the management of centrally located HCCs.