Application effect of contrast-enhanced ultrasound combined with mixed reality technology in laparoscopic anatomical hepatectomy

Lou Li-Ping; Zhang Ling-Qiao; Liu Hai-Chao

doi:10.11855/j.issn.0577-7402.0302.2023.0801

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Application effect of contrast-enhanced ultrasound combined with mixed reality technology in laparoscopic anatomical hepatectomy

Clinical Research | 更新时间：2023-11-09

- Application effect of contrast-enhanced ultrasound combined with mixed reality technology in laparoscopic anatomical hepatectomy
- Medical Journal of Chinese People′s Liberation Army Vol. 48, Issue 10, Pages: 1208-1213(2023)
- 作者机构：
  
  1.郑州大学附属洛阳中心医院超声科，河南洛阳　471000
  2.郑州大学附属洛阳中心医院肝胆外科，河南洛阳　471000
- 作者简介：
  
  E-mail: 1281733563@qq.com
- 基金信息：
  
  Joint Construction Project of Henan Provincial Health Commission(LHGJ20191194)
- DOI：10.11855/j.issn.0577-7402.0302.2023.0801
  CLC：
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娄丽平, 张灵巧, 刘海潮. 超声造影联合混合现实技术在腹腔镜解剖性肝切除术中的应用效果[J]. 解放军医学杂志, 2023, 48(10): 1208-1213.

Lou Li-Ping,Zhang Ling-Qiao,Liu Hai-Chao.Application effect of contrast-enhanced ultrasound combined with mixed reality technology in laparoscopic anatomical hepatectomy[J].Medical Journal of Chinese People′s Liberation Army,2023,48(10):1208-1213.
娄丽平, 张灵巧, 刘海潮. 超声造影联合混合现实技术在腹腔镜解剖性肝切除术中的应用效果[J]. 解放军医学杂志, 2023, 48(10): 1208-1213. DOI： 10.11855/j.issn.0577-7402.0302.2023.0801.

Lou Li-Ping,Zhang Ling-Qiao,Liu Hai-Chao.Application effect of contrast-enhanced ultrasound combined with mixed reality technology in laparoscopic anatomical hepatectomy[J].Medical Journal of Chinese People′s Liberation Army,2023,48(10):1208-1213. DOI： 10.11855/j.issn.0577-7402.0302.2023.0801.

摘要

目的,2,探讨超声造影(CEUS)联合混合现实(MR)技术在腹腔镜解剖性肝切除术中的应用效果。,方法,2,回顾性分析2019年1月－2022年6月在郑州大学附属洛阳中心医院行腹腔镜下解剖性肝切除术的45例原发性肝癌患者，术前均行腹部薄层增强CT扫描，采集数据构建肝脏三维可视化模型。根据术中影像学辅助方法不同将患者分为观察组(,n,=25，术中采用CEUS联合MR技术为手术提供精准导航)与对照组(,n,=20，行常规解剖性肝切除术，术中不实施CEUS及MR技术)。术后随访至2023年1月，记录并比较两组患者病灶大小、手术时间、选择性入肝血流阻断时间、术中出血量、术中及术后并发症、R0切除率、住院时间、术后肝肾功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐]、生存时间等临床指标。,结果,2,除对照组3例中转开腹外，余42例均于腹腔镜下顺利实施手术。两组病灶大小差异无统计学意义[(5.6±1.1) cm ,vs. ,(5.4±1.3) cm，,P,>,0.05]。观察组术中选择性入肝血流阻断时间、手术时间明显短于对照组[(27.1±6.8) min ,vs. ,(46.9±4.3) min，,P,<,0.001；(135.4±4.3) min ,vs. ,(199.3±5.8) min，,P,<,0.001]，术中出血量及输血量均明显少于对照组[(102.7±10.1) ml, vs. ,(259.4±16.9) ml，,P,<,0.001；(120.7±9.6) ml, vs. ,(247.4±12.3) ml，,P,<,0.001]，术后24 h ALT及AST水平均明显低于对照组[(96.7±23.7) U/L ,vs. ,(185.3±38.5) U/L，,P,<,0.001；(91.4±30.9) U/L ,vs. ,(198.1±42.6) U/L，,P,<,0.001]。观察组发生术后肺部感染1例(1/25，4.0%)，非手术治疗后恢复；对照组发生术中大出血导致中转开腹3例(3/20，15.0%)，术后肺部感染2例(2/20，10.0%)，胃排空功能障碍2例(2/20，10.0%)，均非手术治疗后恢复；两组术后均未发生腹腔内出血、胆瘘等其他并发症；观察组并发症发生率低于对照组，差异有统计学意义(,P,=0.021)。两组术后24 h肌酐水平、R0切除率、术后住院时间差异无统计学意义[(57.4±18.2) μmol/L, vs., (58.1±17.6) μmol/L，,P,>,0.05；100.0%(25/25) ,vs., 90.0%(18/20)，,P,>,0.05；(8.4±2.2) d ,vs., (8.9±1.9) d，,P,>,0.05]；观察组中位生存期长于对照组，但差异无统计学意义[18.5(9.2，24.5)月 ,vs., 18.0(8.7，23.0)月，,P,>,0.05]。,结论,2,CEUS联合MR技术应用于腹腔镜解剖性肝切除术中安全、有效，有助于缩短手术时间，减少术中出血，完整切除肿瘤，提高治疗效果，具有较好的临床应用价值。

Abstract

Objective,2,To explore the efficacy of contrast-enhanced ultrasound (CEUS) combined with mixed reality (MR) in laparoscopic anatomical hepatectomy.,Methods,2,The clinical data of 45 patients with primary liver cancer who underwent laparoscopic anatomical hepatectomy in Luoyang Central Hospital Affiliated to Zhengzhou University from January 2019 to June 2022 were retrospectively analyzed. All patients underwent abdominal thin-layer enhanced CT scan before operation, then collected data to build a three-dimensional visualization model of the liver. According to the auxiliary method of intraoperative imaging, the patients were divided into observation group (,n,=25, CEUS combined with MR technology was used to provide precise navigation for surgery) and the control group (,n,=20, routine anatomical hepatectomy was performed, and CEUS and MR technology were not used during surgery). The postoperative follow-up was to January 2023. The size of the lesion, the time of operation, the time of selective hepatic blood flow blockade, the amount of intraoperative bleeding, the intraoperative and postoperative complications, the rate of R0 resection, the length of hospital stay, the postoperative liver function [alanine aminotransferase (ALT), aspartate aminotransferase(AST), creatinine level], and the survival time were recorded and compared between two groups.,Results,2,The remaining 42 patients were successfully operated under laparoscopy except for 3 patients in control group who were converted to laparotomy. There was no statistically significant difference in lesion size between the two groups [(5.6±1.1) cm, vs., (5.4±1.3) cm,P,>,0.05]. The observation group had significantly shorter intraoperative selective hepatic blood flow blockade time and surgical time compared to control group [(27.1±6.8) min ,vs., (46.9±4.3) min,P,<,0.001; (135.4±4.3) min ,vs., (199.3±5.8) min,P,<,0.001]. The intraoperative blood loss and transfusion volume of observation group were significantly lower than those in control group [(102.7±10.1) ml ,vs., (259.4±16.9) ml,P,<,0.001; (120.7±9.6) ml ,vs. ,(247.4±12.3) ml,P,<,0.001], the levels of ALT and AST were significantly lower than those in control group 24 h after operation [(96.7±23.7) U/L ,vs., (185.3±38.5) U/L,P,<,0.001; (91.4±30.9) U/L ,vs., (198.1±42.6) U/L,P,<,0.001]. One patient in the observation group developed postoperative pulmonary infection (1/25, 4.0%), and recovered after conservative treatment. In the control group, 3 patients (3/20, 15.0%) underwent massive intraoperative hemorrhage, resulting in conversion to laparotomy, 2 patients (2/20, 10.0%) experienced postoperative pulmonary infection, and 2 patients (2/20, 10.0%) experienced gastric emptying dysfunction, all patients recovered after conservative treatment. Neither patient in the two groups experienced abdominal bleeding, biliary fistula and other complications after operation. The incidence of complications in the observation group was lower than that in control group, and the difference was statistically significant (,P,=0.021). There was no statistically significant difference in postoperative creatinine levels, R0 resection rate, and postoperative hospital stay between the two groups [(57.4±18.2) μmol/L ,vs., (58.1±17.6) μmol/L,P,>,0.05; 100.0%(25/25) ,vs., 90.0%(18/20),P,>,0.05; (8.4±2.2) d ,vs. ,(8.9±1.9) d,P,>,0.05]; The median survival time of observation group was longer than that of control group, but the difference was not statistically significant [18.5(9.2, 24.5) months ,vs. ,18.0 (8.7, 23.0) months,P,>,0.05].,Conclusion,2,The combination of CEUS and MR technology is safe and effective in laparoscopic anatomical hepatectomy, which can shorten the operation time, reduce intraoperative bleeding, completely remove the tumor, and improve the treatment effect, and has good clinical application value.

关键词

超声造影混合现实技术腹腔镜解剖性肝切除术

Keywords

contrast-enhanced ultrasoundmixed reality technologylaparoscopeanatomical hepatectomy

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