• 1.解放軍第324醫(yī)院普通外科（重慶 400020）;;
  • 2.重慶大學(xué)計算機(jī)科學(xué)學(xué)院（重慶 400038）;;
  • 3.解放軍總醫(yī)院肝膽外科（北京 100853）;

目的  將新研發(fā)的肝臟虛擬手術(shù)系統(tǒng)(LiVirtue)應(yīng)用于臨床，制訂合理的手術(shù)方案，降低手術(shù)風(fēng)險，完成精準(zhǔn)手術(shù)。
方法  應(yīng)用LiVirtue系統(tǒng)對32例肝右葉腫瘤患者進(jìn)行個體化分析，實現(xiàn)對肝臟精確測量、分割，測定各靜脈的回流區(qū)域; 直觀顯示肝內(nèi)脈管的分布及變異情況; 模擬肝切除的多種手術(shù)方式等，選擇合理手術(shù)方案，并與術(shù)中實際情況進(jìn)行對比。
結(jié)果  肝臟虛擬手術(shù)系統(tǒng)可對肝臟體積、區(qū)域分割、脈管吻合等情況進(jìn)行快速準(zhǔn)確的個性化分析; 可模擬肝臟外科多種手術(shù)方式，有助于確定合理手術(shù)方案; 與32例右肝腫瘤行肝切除術(shù)的術(shù)中對比，顯示該系統(tǒng)虛擬性好，術(shù)前模擬結(jié)果準(zhǔn)確，術(shù)中未損傷正常結(jié)構(gòu)，降低了術(shù)中風(fēng)險; 所建立的模型也可在便攜PC機(jī)上展示，方便于術(shù)中對照。
結(jié)論  LiVirtue系統(tǒng)有助于揭示個體肝臟的解剖特點(diǎn)，確定合理的手術(shù)方式，降低了手術(shù)風(fēng)險，保證了手術(shù)安全。

引用本文： 陳剛,李學(xué)成,熊曉峰,吳國慶,楊日高,王翊,凡桂華,房斌,楊世忠,董家鴻. 肝臟虛擬手術(shù)系統(tǒng)在肝右葉腫瘤手術(shù)中的臨床應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(1): 64-67. doi: 復(fù)制

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11. Urata K, Kawasaki S, Matsunami H, et al. Calculation of child and adult standard liver volume for liver transplantation [J]. Hepatology, 1995; 21(5): 13171321.
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13. Soler L, Delingette H, Malandain G, et al. An automatic virtual patient reconstruction from CTscans for hepatic surgical planning [J]. Stud Health Technol Inform, 2000; 70: 316322.
14. Hiroshige S, Nishizaki T, Soejima Y, et al. Beneficial effects of 3dimensional visualization on hepatic vein reconstruction in living donor liver transplantation using right lobe graft [J]. Transplantation, 2001; 72(12): 19931996.
15. Radtke A, Nadalin S, Sotiropoulos GC, et al. Computerassisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein [J]. World J Surg, 2007; 31(1): 175185.
16. Glombitza G, Lamade W, Demiris AM, et al. Virtual planning of liver resections: image processing, visualization and volumetric evaluation [J]. Int J Med Inform, 1999; 53(23): 225237.
17. Mortele KJ, McTavish J, Ros PR. Current techniques of computed tomography. Helical CT, multidetector CT, and 3D reconstruction [J]. Clin Liver Dis, 2002; 6(1): 2952.
18. Uchida M, Ishibashi M, Sakoda J, et al. CT image fusion for 3D depiction of anatomic abnormalities of the hepatic hilum [J]. Am J Roentgenol, 2007; 189(4): W184W191.
19. 沈嘯洪, 李慧鍇, 張倜, 等. 肝癌外科規(guī)范化治療若干問題探討 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(4): 261264.
20. 樊嘉, 黃成. 原發(fā)性肝癌外科治療的進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(4): 257260.
21. 方馳華, 周五一, 黃立偉, 等. 虛擬中國人女性一號肝臟圖像三維重建和虛擬手術(shù)的切割 [J]. 中華外科雜志, 2005; 43(11): 748752.
22. 朱新勇, 方馳華, 鮑蘇蘇, 等. 基于64排螺旋CT掃描數(shù)據(jù)的肝臟圖像分割和三維重建 [J]. 南方醫(yī)科大學(xué)學(xué)報, 2008; 28(3): 345347.
23. 陳剛, 晉云, 譚立文, 等. 三維數(shù)字虛擬人體肝臟系統(tǒng)的建立及其應(yīng)用 [J]. 第三軍醫(yī)大學(xué)學(xué)報, 2008; 30(22): 21032106.
24. 陳剛, 張紹祥, 晉云, 等. 三維數(shù)字虛擬肝臟對肝臟尾狀葉外科應(yīng)用解剖的研究 [J]. 中華肝膽外科雜志; 2008; 14 (12): 858861.
25. Chen G, Zhang SX, Tan LW, et al. The study of threedimensional reconstruction of Chinese adult liver [J].Surg Radiol Anat, 2009; 31(6): 453460.
  1. 1. Bruix J, Hessheimer AJ, Forner A, et al. New aspects of diagnosis and therapy of hepatocellular carcinoma [J]. Oncogene, 2006; 25(27): 38483856.
  2. 2. DeMatteo RP, Fong Y, Blumgart LH. Surgical treatment of malignant liver tumours [J]. Baillieres Best Pract Res Clin Gastroenterol, 1999; 13(4): 557574.
  3. 3. Yong T, Bohmer R, Pande G, et al. Liver resection: a regional hospital experience [J]. ANZ J Surg, 2007; 77(Suppl.1): A40.
  4. 4. Lau WY, Lai EC. Hepatocellular carcinoma: current management and recent advances [J]. Hepatobiliary Pancreat Dis Int, 2008; 7(3): 237257.
  5. 5. Parks RW, Garden OJ. Liver resection for cancer [J]. World J Gastroenterol, 2001; 7(6): 766771.
  6. 6. Heriot AG, Karanjia ND. A review of techniques for liver resection [J]. Ann R Coll Surg Engl, 2002; 84(6): 371380.
  7. 7. Dulucq JL, Wintringer P, Rashid LM. Virtually bloodless laparoscopic liver resection of recurrent hepatoma with a new laparoscopic sealer device: report of our initial laparoscopic experience [J]. Surg Laparosc Endosc Percutan Tech, 2007; 17(5): 413415.
  8. 8. Billingsley KG, Jarnagin WR, Fong Y, et al. Segmentoriented hepatic resection in the management of malignant neoplasms of the liver [J]. J Am Coll Surg, 1998; 187(5): 471481.
  9. 9. Herfarth C, Lamade W, Fischer L, et al. The effect of virtual reality and training on liver operation planning [J]. Swiss Surg, 2002; 8(2): 6773.
  10. 10. Lang H, Radtke A, Liu C, et al. Extended left hepatectomymodified operation planning based on threedimensional visualization of liver anatomy [J]. Langenbecks Arch Surg, 2004; 389(4): 306310.
  11. 11. Urata K, Kawasaki S, Matsunami H, et al. Calculation of child and adult standard liver volume for liver transplantation [J]. Hepatology, 1995; 21(5): 13171321.
  12. 12. Bjerner T, Johansson L, Haglund U, et al. 3D surface rendering of images from multiple MR pulse sequences in the preoperative evaluation of hepatic lesions [J]. Acta Radiol, 1998; 39(6): 698700.
  13. 13. Soler L, Delingette H, Malandain G, et al. An automatic virtual patient reconstruction from CTscans for hepatic surgical planning [J]. Stud Health Technol Inform, 2000; 70: 316322.
  14. 14. Hiroshige S, Nishizaki T, Soejima Y, et al. Beneficial effects of 3dimensional visualization on hepatic vein reconstruction in living donor liver transplantation using right lobe graft [J]. Transplantation, 2001; 72(12): 19931996.
  15. 15. Radtke A, Nadalin S, Sotiropoulos GC, et al. Computerassisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein [J]. World J Surg, 2007; 31(1): 175185.
  16. 16. Glombitza G, Lamade W, Demiris AM, et al. Virtual planning of liver resections: image processing, visualization and volumetric evaluation [J]. Int J Med Inform, 1999; 53(23): 225237.
  17. 17. Mortele KJ, McTavish J, Ros PR. Current techniques of computed tomography. Helical CT, multidetector CT, and 3D reconstruction [J]. Clin Liver Dis, 2002; 6(1): 2952.
  18. 18. Uchida M, Ishibashi M, Sakoda J, et al. CT image fusion for 3D depiction of anatomic abnormalities of the hepatic hilum [J]. Am J Roentgenol, 2007; 189(4): W184W191.
  19. 19. 沈嘯洪, 李慧鍇, 張倜, 等. 肝癌外科規(guī)范化治療若干問題探討 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(4): 261264.
  20. 20. 樊嘉, 黃成. 原發(fā)性肝癌外科治療的進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(4): 257260.
  21. 21. 方馳華, 周五一, 黃立偉, 等. 虛擬中國人女性一號肝臟圖像三維重建和虛擬手術(shù)的切割 [J]. 中華外科雜志, 2005; 43(11): 748752.
  22. 22. 朱新勇, 方馳華, 鮑蘇蘇, 等. 基于64排螺旋CT掃描數(shù)據(jù)的肝臟圖像分割和三維重建 [J]. 南方醫(yī)科大學(xué)學(xué)報, 2008; 28(3): 345347.
  23. 23. 陳剛, 晉云, 譚立文, 等. 三維數(shù)字虛擬人體肝臟系統(tǒng)的建立及其應(yīng)用 [J]. 第三軍醫(yī)大學(xué)學(xué)報, 2008; 30(22): 21032106.
  24. 24. 陳剛, 張紹祥, 晉云, 等. 三維數(shù)字虛擬肝臟對肝臟尾狀葉外科應(yīng)用解剖的研究 [J]. 中華肝膽外科雜志; 2008; 14 (12): 858861.
  25. 25. Chen G, Zhang SX, Tan LW, et al. The study of threedimensional reconstruction of Chinese adult liver [J].Surg Radiol Anat, 2009; 31(6): 453460.