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目的探讨计算机辅助手术系统(海信CAS)在小儿巨大肝间叶性错构瘤(HMH)诊治中的临床价值。方法自2010年9月至2015年10月,我们收治5例HMH患儿,术前均行上腹部增强CT检查,3例(2013年7月至2015年10月)应用海信CAS对患儿CT资料行三维重建及模拟肝切除,制定手术计划,术中实施精准肝切除术。结果 2例(2010年9月至2013年5月)根据术前CT检查分别实施肝右叶切除术及肝左叶切除术。3例(2013年7月至2015年10月)应用海信CAS系统成功进行肝脏及肿瘤的三维重建,并进行模拟肝切除,根据术前制定的手术计划分别成功实施:肝Ⅱ、Ⅲ、Ⅴ、Ⅷ部分及Ⅳ全部切除术,肝Ⅴ段切除术,右半肝切除术。术后恢复好,病理检查证实为HMH。随访3个月至5年未见并发症及复发。结论 HMH影像学检查与肝囊肿相似,易误诊。海信CAS能清晰、直观显示HMH的位置、形态及其与肝内管道系统的关系,其术前规划功能利于术者制定最佳手术方案,实施个体化精准肝脏肿瘤切除。
Objective To investigate the clinical value of computer-assisted surgery (Hisense CAS) in the diagnosis and treatment of pediatric giant hepatic lobar hamartoma (HMH). Methods From September 2010 to October 2015, we treated 5 children with HMH who underwent enhanced abdominal CT before operation and 3 patients (July 2013 to October 2015) Data line reconstruction and simulated liver resection, the development of surgical plans, intraoperative implementation of precision hepatectomy. Results Two cases (September 2010 to May 2013) underwent right hepatectomy and left hepatectomy under preoperative CT examination. Three patients (July 2013 to October 2015) successfully performed three-dimensional reconstruction of the liver and tumor using Hisense CAS system and simulated hepatectomy. The patients were successfully performed according to the preoperative surgical plans: liver Ⅱ, Ⅲ, Ⅴ, Ⅷ part and Ⅳ total resection, liver Ⅴ segmentectomy, right hemihepatectomy. Postoperative recovery is good, pathological examination confirmed as HMH. Follow-up 3 months to 5 years no complications and recurrence. Conclusions HMH imaging is similar to hepatic cyst and easily misdiagnosed. Hisense CAS clearly and visually shows the location and shape of the HMH and its relationship with the intrahepatic duct system. Its preoperative planning function helps the surgeon in formulating the optimal surgical plan and implementing personalized and accurate liver tumor resection.