目的：探讨术前双源CT 下肝血管造影三维重建成像联合术中区域血流阻断美蓝持久染色在精准肝切除术中的应用价值。方法：37 例行肝癌患者术前均行双源CT 下肝血管造影成像三维重建，术中先解剖第一肝门，显露预切肝叶/ 段Glisson 鞘各管，从预切肝叶/ 段门静脉属支（门静脉有癌栓者从胆管）注入美蓝染色，阻断拟切除肝血流，按染色的界限行肝叶/ 段切除。将该37 例患者（观察组）与同期32 例行传统肝切除手术肝癌患者（对照组）作比较。结果：观察组37 例行精准肝切除患者术前肝血管造影成像和术中肝脏染色相一致。与对照组比较，观察组手术时间延长，切肝出血量减少，肝功能指标变化小、恢复快，并发症发生率降低，住院时间缩短（均P<0.05）。结论：双源CT 下肝血管造影成像三维重建联合区域血流阻断美蓝持久染色应用于精准肝切除手术，能减少出血，避免误伤保留肝脏的Glisson 管道，减少肝功能损害和手术并发症。
Application of hepatic angiography with 3-D reconstruction plus regional blood flow occlusion and persistent methylene blue dyeing in precise hepatectomy
Objective: To determine the application value of preoperative dual-source CT (DSCT) hepatic angiography with 3-D reconstruction plus intraoperative regional blood flow occlusion and persistent methylene blue dyeing in precise liver resection. Methods: Thirty-seven liver cancer patients underwent DSCT hepatic tumor angiography with 3-D reconstruction, followed by the surgical procedure that in order included dissection of the first hepatic hilum, exposure of each vessel enveloped by the sheath of Glisson’s capsule into the lobe or segments to be resected, methylene blue injection through the tributaries of the portal vein (or through the bile duct in cases with portal vein tumor thrombus) to the lobe or segments to be resected, and then occlusion of blood flow of the liver to be resected, and lobectomy or segmentectomy according to the boundary of methylene blue dyeing. These 37 patients (observational group) were compared with 32 liver cancer patients undergoing conventional liver resection (control group) during the same period. Results: In the 37 cases of observational group undergoing precise liver resection, the results of preoperative hepatic angiography were consistent with the views of intraoperative liver staining. Compared with control group, in observational group, the operative time was prolonged, but the blood loss during liver resection was reduced, the changes in liver function parameters were mild with quicker recovery, the incidence of postoperative complications was decreased and the length of hospital stay was shortened (all P<0.05). Conclusion: Using preoperative hepatic angiography and 3-D reconstruction plus persistent methylene blue dyeing and regional blood flow occlusion in precise liver resection can reduce bleeding, avoid injury of the vessels of Glisson’s system of the preserved liver tissue, and reduce the damage of liver function and surgical complications.