| Purpose Hepatoblastoma(HB)is the most common primary liver tumor and the third most common abdominal neoplasm after neuroblastoma and nephroblastoma in childhood.The incidence of HB has increased in recent years.The introduction of neoadjuvant chemotherapy regimens allows many initially unresectable tumors to be safely removed.A complete surgical resection remains the mainstay of hepatoblastoma treatment.To completely resect HB,the surgical team must grasp the tumor extent which is determined from computed tomography(CT)imaging.Nevertheless,intraoperative use of conventional CT imaging is based on cognitive analysis by the surgeon.The accuracy and precise use of such human interpretation relies largely on knowledge and experience.Hisense CAS is an operation planning software to transpose on 2D images into 3D,afterwards integrate preoperative data into the operative field.This study is to assess the impact of Hisense CAS on the actual surgical procedures in pediatric patients with HB.Objective The 3D simulated function of the surgical planning system can realize the diagnosis of rare diseases and anatomical structures in children.Simultaneously,this study aimed to illustrate the first diagnoses in juxtarenal Wilms tumor using 3D simulation after percutaneous biopsy,to diagnote the type IV hepatic vein,and to use the previous 3D simulation data model to form an open large data platform.Methods 21 pediatric patients with HB(2011.9-2013.8,The Affilited Hospital of Qingdao University,the Department of Pediatric Surgery)were enrolled in this study.All patients underwent CT imaging preoperatively.10 cases(between September 2011 and August 2013)whose CT imaging were not preoperatively analyzed using Hisense CAS were selected as the control group.11 cases(between September 2013 and August 2015)constituted the test group,which the surgical team drew up an individualized operation planning using Hisense CAS,and performed the hetpatectomy for patients.CT was Sensation64,Siemens,Erlangen,Germany.PACS was General Electric Company(GE),America.Contrast agent was Ultravist,Bayer Health Care LLC,Germany.Hisense CAS was Hisense Gemini 3D Medical Imaging Reconstruction and Computer Assisted Surgery System.Hisense SID was Hisense Surgical Intelligent Display system.The data of 2 groups were statistically analysed using SPSS ver.19.0 for Windows.Statistical analysis: Age,weight,height,time of operation,amount of bleeding,postoperative hospital stay were marked as mean ± standard deviation,and Mann-Whitney U test was used for statistical analysis.Gender,surgical Surgical procedures(routine/expanded),AFP(>/<1210mg/ml)were analyzed by Percentage of the Soviet Union and ?2 test was used for statistical analysis.P<0.05 was taken to indicate statistical significance.Review the current data of juxtarenal Wilms tumor based on the selective literatures in MEDLINE.From manifestations to treatment,the case of juxtarenal Wilms tumor demonstrates the 3D simulation after percutaneous biopsy.A case of giant Hepatic Mesenchymal hamartoma illustrates the role of 3D simulation in the clear hepatic vein classification.Through the summary of the previous data,an open digital liver platform would be established.Results There were satisfied with the CT imaging data in control group and test group.In test group,Hisense CAS successfully provided the 3D imaging of liver structures,displayed virtual hepatectomy.The individualized anatomic hepatectomy were successfully completed for all patients after operation planing using Hisense CAS.There was no obvious discrepancy between the virtual and the actual hepatectomy.There was no statistical significance in gender(P = 0.275),age(P = 0.481),height(P = 0.378),weight(P = 0.306)and AFP(P = 0.127)between control group and test group.There was no statistical significance in surgical procedures(routine/expanded P=0.827)between control group and test group.The mean operation time was 142.18±21.87 min in the test group VS.173.5±54.88 min in the control group(P=0.047).The mean intraoperative bleeding volume was 28.73±14.17 ml in the test group VS.42.8±41.12 ml in the control group(P=0.011).2 data indicated statistical significance(P<0.05).The mean postoperative stay was shorter in the test group(11.18±2.78 d VS.the control group 13±3.46d),but the difference was not statistically significant(P=0.257).Control group were follow up for 30-57 mo,7 cases of children were tumor-free survival,2 cases of recurrence,1 case died due to multiple metastases.Test group were follow up for 2-27 mo,11 cases of children were tumor-free survival,no recurrence.Because of the two groups of children for different periods of surgery in children,the follow-up statistical test was meaningless.There are 17 cases of well-documented juxtarenal Wilms tumor in MEDLINE.Juxtarenal Wilms tumors approximately represent 5.67% of extrarenal Wilms tumors.3D context of the case was successfully reconstructed.Radical tumorectomy was completed with no anatomic discrepancy between the 3D simulation and the surgery.3D simulation after percutaneous biopsy can correctly diagnosed juxtarenal Wilms tumor visually,and facilitate a precise anatomical tumorectomy.Hepatic vein function and classification were changed and affected with the human development and diseases.3D simulation model can visually show the hepatic vein.Giant liver tumors can affect the development of hepatic vein,3D simulation model can confirm the diagnosis of hepatic vein type.3D simulation model take a method for the vitro study of the hepatic vein.A big data of 3D simulation model can establish a Human Digital Liver Databank,which is an open digital liver platform.The establishment of Human Digital Liver Databank can abandon same uncertain factors,such as rare disease,clinical data incomplete,follow-up failure,which provides valuable data resources for the study of the human liver diseases.Conclusions The investigation of unknown fields and the virtual hepatectomy using Hisense CAS is important contributions to the optimal operation planning of the complex procedures in pediatric patients with HB.With the aid of Hisense CAS,an individualized anatomic hepatectomy may become more available for the different pediatric patient with HB,which would effectively shorten the operation time and reduce the intraoperative bleeding volume.The end result is the reduction of the surgical trauma and the postoperative stay.Hisense CAS as a surgical planning software can also be used for the diagnosis and treatment of rare diseases,study on hepatic vein typing,and provide effective data for resource sharing. |
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