肝胆胰外科杂志2025，Vol.37Issue(5)：295-302,8.DOI:10.11952/j.issn.1007-1954.2025.05.002
CT三维重建联合术中超声3D腹腔镜单纯性大肝囊肿切除术的疗效分析
Efficacy of CT three-dimensional reconstruction combined with intraoperative ultrasound and three-dimensional laparoscopic resection for large simple hepatic cysts
摘要
Abstract
Objective To explore the technique and efficacy of CT three-dimensional(3D)reconstruction combined with intraoperative ultrasound and 3D laparoscopic resection for large simple hepatic cysts(LSHC).Methods A retrospective analysis was conducted on the perioperative and follow-up data of 59 patients,who were diagnosed with LSHC and underwent either LSHC resection(resection group,n=29)or deroofing fenestration(fenestration group,n=30)in Hunan Provincial People's Hospital between Nov.1,2021,and Jan.1,2024.The patients in the resection group underwent 3D reconstruction based on thin-slice CT of the liver before surgery,followed by intraoperative ultrasound-guided 3D laparoscopic hepatic cystectomy or lobectomy.Patients in the fenestration group underwent laparoscopic fenestration of cysts.The cumulative sum(CUSUM)analysis was utilized to assess the surgical learning curve of 3D reconstruction combined with intraoperative ultrasound and 3D laparoscopic resection for LSHC.Subsequently,the perioperative indicators between the learning phase and the proficient phase in the surgical learning curve were compared.Results Compared with the fenestration group,the operation time in the resection group was significantly longer[190.0(130.0,230.0)min vs 66.5(50.0,85.0)min,P<0.001],the intraoperative blood loss was significantly more[70.0(50.0,120.0)mL vs 20.0(10.0,30.0)mL,P<0.001],and the postoperative hospitalization time was significantly longer[7.0(6.0,9.0)d vs 6.0(4.0,7.0)d,P<0.05].The median follow-up time was 21(14,40)months.The recurrence rate of cyst in the resection group was significantly lower than that in the fenestration group(0 cases vs 8 cases,P<0.01).There was neither conversion to laparotomy nor deaths case in both group.Analysis of the surgical learning curve for the resection group showed that,the initial 11 cases corresponded to the learning phase,while the subsequent 18 cases fell within the proficient phase.Compared with the learning phase,both the mean operation time[(169.9±58.1)min vs(242.5±63.2)min,P<0.01]and the postoperative hospitalization time[(6.1±2.1)d vs(9.5±2.7)d,P<0.01]in the proficient phase were significantly reduced.Conclusion CT 3D reconstruction combined with intraoperative ultrasound and 3D laparoscopic resection for LSHC exhibits remarkable safety,extensive generalizability,and an exceedingly low postoperative recurrence rate of cyst.关键词
单纯性肝囊肿/大囊肿/CT三维重建/术中超声/腹腔镜手术/囊肿切除术/学习曲线Key words
simple hepatic cyst/large cyst/CT three-dimensional reconstruction/intraoperative ultrasound/laparoscopy/cystectomy/learning curve分类
临床医学引用本文复制引用
刘子雄,李俊韬,杨俊,李云峰,陈康,彭创,周磊,尹新民,成伟..CT三维重建联合术中超声3D腹腔镜单纯性大肝囊肿切除术的疗效分析[J].肝胆胰外科杂志,2025,37(5):295-302,8.基金项目
国家临床重点专科建设项目(20191127-1001) （20191127-1001）
湖南省卫生健康高层次人才重大科研专项(R2023096). （R2023096）
