目的 研究三维可视化技术在肝门胆管癌术前评估中的应用价值。方法 回顾性分析我院普外科2018年6月至2019年1月期间15例行肝门胆管癌根治术病人的临床资料。行上腹CT检查,利用3D-Liver软件进行三维可视化重建,评估解剖变异、肿瘤分型、血管侵犯以及肿瘤可切除性,并作术前手术规划。观察术中探查与术前评估的一致性、手术时间、出血量以及围术期并发症发生。结果 应用三维可视化技术评估15例病人Bismuth-Corlette分型：Ⅱ型3例,Ⅲ型10例,Ⅳ型2例。全肝体积（1 286.06±321.56） mL,左半肝体积（451.90±173.98） mL,右半肝体积（834.14±220.34） mL,肿瘤体积为（15.19±12.91） mL。80%（12/15）的病人按术前规划完成肝门胆管癌根治术。肝动脉变异5例,肝静脉变异4例,门静脉变异1例。术中所见与评估一致。肝脏切除11例。手术时间（343±111） min,出血量（355±189） mL。结论 三维可视化技术在肝门胆管癌术前评估中有重要的参考价值,保障手术的安全性。
Objective To evaluate the resectability of hilar cholangiocarcinoma using three-dimensional visualization technique. Methods A retrospective analysis was done using the clinical data of 15 patients with hilar cholangiocarcinoma who underwent radical dissection between June 2018 and January 2019 in Department of General Surgery Zhongshan Hospital. Epigastric computed tomography scan combined with three-dimensional visualization by 3D-Liver imaging analysis system was performed for assessment of anatomical variants, tumor classification, vascular invasion, respectability and preoperational planning. We compared preoperative assessment with operative finding, and analyzed operative time, blood loss and peri-operative complication. Results Based on three-dimensional visualization of Bismuth-Corlette classification, there were 3 cases in type Ⅱ, 10 cases in type Ⅲ, and 2 cases in type Ⅳ. Liver volume was evaluated (1 286.06± 321.56) mL, and left and right liver volume were (451.90± 173.98) mL and (834.14± 220.34) mL, respectively. The tumor volume was evaluated as (15.19± 12.91) mL. Twelve in 15 patients (80%) completed radical resection, which was consistent with preoperative evaluation. There were 5 cases with variant hepatic artery, 4 cases with variant hepatic vein and 1 case with variant portal vein, which was all correctly evaluated preoperatively. Eleven patients had liver resection. Operative time was (343± 111) minutes with blood loss (355± 189) mL. Conclusions Three-dimensional visualization had important role in preoperative assessment of hilar cholangiocarcinoma and allowing operation safety.
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