Application of three-dimensional reconstruction in the resection of complex liver cancer
Objective To investigate the clinical values of three-dimensional reconstruction before the resection of complex liver cancer to the prediction of resected liver volume and to the formulation of surgical plan.Methods Thirty-five patients with complex liver cancer underwent liver resection in Henan Provincial People's Hospital from February,2017 to February,2019,all of them underwent non-contrast CT scan and enhanced scan before operation,and the liver was reconstructed using IQQA-Liver software.The whole liver volume and tumor volume were measured on the two-dimensional and three-dimensional reconstruction images,the surgical plan was simulated on the three-dimensional reconstruction images,and the pre-resected liver volume and residual liver volume were calculated to determine the optimal liver resection method and level.The operative time,intraoperative blood loss,hilar occlusion time,and postoperative complications were recorded,and the actual resected liver volume was calculated.The three-dimensional reconstruction of the pre-resected liver volume was compared with the actual resected liver volume.The correlation between the three-dimensional reconstruction of the pre-resected liver volume and the actual resected liver volume was analyzed by the Pearson correlation method.Results(1)All 35 patients completed the operation in(240±59)min,with the hilar occlusion time of(23.0±8.8)min and the intraoperative blood loss of(517±342)mL.All were confirmed hepatocellular carcinoma by postoperative histopathology.No death occurred in the perioperative period.There were 8 cases of large pleural effusion,5 cases of lung infection,2 cases of incision infection,and 1 case of liver failure,all of whom were discharged after symptomatic supportive treatment.(2)There were no significant differences in the whole liver volume and tumor volume measured by two-dimensional images[(2 316±490),(669±420)cm3]compared with three-dimensional reconstructed images[(2 319±494),(672±427)cm3](t=0.039,P=0.846;t=0.029,P=0.977).There was no significant difference between the pre-resected liver volume[(1 140±430)cm3]and the actual resected liver volume[(1 130±404)cm3](t=0.104,P=0.917).(3)The pre-resected liver volume was positively correlated with the actual resected liver volume(r=0.998,P＜0.001).Conclusion Three-dimensional reconstruction technology can simulate the surgical plan,measure the pre-resected liver tumor volume more accurately and formulate the optiamal surgical plan for patients with complex liver cancer.
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