目的 探讨末梢门静脉栓塞技术和多模态影像技术在巨大肝癌外科手术中的应用价值。 方法 回顾性分析 2018 年 2 月至 2021 年 11 月肝胆外科收治的使用多模态影像技术指导的 52 例巨大肝癌 患者临床资料，根据治疗方式分为直接手术切除组（对照组，27 例）和末梢门静脉栓塞术序贯手术切除 组（研究组，25 例）。多模态影像技术融合三维重建、可视化、3D 打印、增强现实技术，进行术前评估、 手术规划和手术导航；末梢门静脉栓塞技术彻底阻断两侧肝脏间门静脉系统交通支，促进剩余肝脏体 积（FLR）增生后行手术治疗。观察分析两组患者围手术期情况如手术方式、手术时间、术中出血量等， 以及疗效如并发症、复发或转移情况等。结果 52 例患者均成功完成多模态影像技术指导下的术前评 估、手术规划和术中导航，研究组患者末梢门静脉栓塞术后 FLR 获不同程度增生 93 ~ 322 cm3 ，中位增 生体积 183 cm3 。所有患者均顺利完成手术，未发生围手术期死亡。术后均未发生严重并发症如出血、 胆漏、肝功能衰竭等。研究组入肝血流阻断时间、术中出血量、术后住院时间、术后并发症发生率分别 为（27.6 ± 11.6）min、236（100）mL、（10.8 ± 2.4）d、12.0%（3/25），明显少于对照组的（34.4 ± 10.9）min、 292（150）mL、（13.1 ± 4.1）d、37.0%（10/27），差异有统计学意义（P < 0.05）。研究组和对照组手术时间 分别为（209.6 ± 36.5）、（237.0 ± 69.1）min，差异无统计学意义（P > 0.05）。研究组和对照组术后复发或转 移各 5、11 例，两组复发差异无统计学意义（χ2 = 0.735，P > 0.05）。结论 末梢门静脉栓塞技术和多模态影像技术通过增加剩余肝脏体积、精准术前规划和手术导航，可提高巨大肝癌外科手术治疗的安全性和手术效果。 

Objective To evaluate the clinical application of the terminal branches portal vein emboliza⁃ tion and multimode imaging technology in precise hepatectomy for patients with huge hepatocellular carcinoma. Methods Clinical data of 52 patients of huge hepatocellular carcinoma underwent precise hepatectomy with the help of multimode imaging technology in Yuebei People′s Hospital between Feb. 2018 and Nov. 2021 were retrospec⁃ tively analyzed. According to the treatment method，the patients were divided into direct surgical resection group （control group，27 cases）. And terminal branches portal vein embolization followed by surgical resection group （study group，25 cases）. The multimode imaging technology fusing three⁃dimensional reconstruction which convert⁃ ed from CT imaging，three⁃dimensional visualization，three dimensional printing and augmented reality in assess⁃ ing the hepatic anatomy，instructing preoperative planning and navigating operation. The terminal branches portal vein embolization technology blocked the interconnected portal vein of the two sides of the liver，and promoted the future liver remnant before surgery. Perioperative results and postoperative efficacy of the two groups such as the surgical methods，operative time，intraoperative blood loss，and postoperative complications were observed and analyzed. Results The multimode imaging technology were successfully applied in all 52 patients，achieved satis⁃ fying preoperative assessment，surgical planning，and intraoperative navigation. The future liver remnant of patients in the study group were promoted effectively，（93 ~ 322 mL，media183 mL）. All patients underwent surgery suc⁃ cessfully，there were none perioperative death，no serious postoperative complications such as bleeding，biliary leakage and liver failure occurred. The hepatic blood flow occlusion time，intraoperative blood loss，postoperative length of stay and the incidence of postoperative complications of the study group were（27.6 ± 11.6）min，236 （100）mL，（10.8 ± 2.4）d，12.0%（3/25），respectively. Significantly less than which in the control group（34.4 ± 10.9 min，292（150）mL，（13.1 ± 4.1）d，37.0%（10/27）（P < 0.05）. The operative time were（209.6 ± 36.5）min and（237.0 ± 69.1）min in the control group respectively，there was no significant difference（P > 0.05）. There were 5 and 11 cases of recurrence respectively in two groups，but no statistical difference between two groups （χ2 = 0.735，P > 0.05）. Conclusion The terminal branches portal vein embolization and multimode imaging tech⁃ nology can improve the safety and effect of precise hepatectomy for patients with huge hepatocellular carcinoma through augmented the future liver remnant，accurate preoperative planning and surgical navigation.