| Purpose1.The aim of this study was to investigate the application value of 3D-visalization combined with ICG-fluorescence technology in the prevention of biliary tract,blood vessel and other side injury during laparoscopic cholecystectomy.2.The study also aimed at probing into the application value of MRI and CT multimodality 3D fusion imaging combined with intraoperative ICG-fluorescence imaging in the diagnosis and treatment of primary liver cancer.Method1.Clinical data of 51 patients who underwent laparoscopic cholecystectomy from January 2017 to August 2017 were collected.Three-dimensional visualization model of the cystic artery,branches of middle hepatic vein or portal vein models was constructed before surgery to evaluate the operation;the use of ICG was divided into two methods:Intravenous injection and intraoperative direct gallbladder injection 12 hours before operation;Main evaluation:variation of gallbladder artery,presence of gallbladder bed exposure in middle hepatic vein and portal vein,fluoroscopy of cystic duct and extrahepatic bile duct;Statistical analysis of the data was considered statistically significant by GrahPad Prism 6.0 software when P value<0.05.2.Data from 41 patients with primary liver cancer from January 2017 to April 2018 were collected,and a three-dimensional fusion model based on thin layer CT and MRI data was constructed using the MI-3DVS system.All patients received ICG 24h before surgery.Among them,patients undergoing anatomic liver dissection were divided into two groups,positive and reversed,and ICG was injected into the peripheral vein or target vein during operation;the observation was based on whether the three-dimensional model was consistent with the intraoperative anatomy and whether the actual operation method in the surgery was consistent with the preoperative virtual surgical protocol.Specifically,preoperative CT and MRI lesion detection;CT and MRI 3D fusion reconstruction and preoperative planning;intraoperative ICG fluorescence imaging of lesion detection;postoperative general conditions and perioperative effect evaluation index.Result1.a)Of the 51 cases,there were 43 cases of common gallbladder artery origin,3 cases of double biliary arteries,4 cases of right hepatic artery from superior mesenteric artery,1 case from gastroduodenal artery,3 cases of exposed middle hepatic vein in the gallbladder bed,45,40 respectively of anterior cystic duct and extrahepatic biliary tract.b)49 cases(96.07%)developed cystic duct development and extrahepatic bile duct development,2 cases showed no fluorescence imaging and no intraoperative bile duct injury.2.Three-dimensional visualization results:a)the 3D reconstruction and visual observation of 41 patients were successfully completed.The 4 branches of the portal and hepatic veins were obtained based on CT data.The exact boundary conditions of the tumor were obtained based on the MRI data.The 3D model of the fusion could clearly show the spatial relationship between the tumor,the trunk and branches of intrahepatic vessels,as well as the extent of compression and invasion of blood vessels;b)Tumor diameter was(3.5±1.2)cm,preoperative standard liver volume was(1232.87±255.82)mL,and the volume of simulated hepatectomy was(279.92±189.50)mL;the residual liver volume was(900.42±285.08)ml after operation.c)41 cases before the operation were found to be 43 lesions by CT,46 lesions were found by MRI and 48 lesions were detected by fluorescein exploration.The actual surgical methods:29 cases of anatomical hepatectomy,including 18 ICG staining cases,6 cases of effective cases,5 cases of dyed failure cases,and 12 cases of non-dissecting hepatectomy.Conclusion1.3D visualization can be used to accurately assess the shape of the gallbladder artery and the exposure of the gall bladder bed in the hepatic vein or portal vein before operation.The intraoperative ICG-fluorescence imaging technology is safe,easy to operate and has high imaging rate and it can identify the bile duct shape and distinguish the peripheral artery from the cystic duct in real time.The combined use of the two methods is helpful to prevent biliary tract injury and abnormal bleeding.2.Multimode fusion 3D imaging combined with intraoperative ICG fluorescence imaging can accurately locate liver cancer lesions during surgery and assist in the definition of tumor boundary and hepatectomy range.Because of its high-sensitivity detection of residual hepatic tissue in liver sections and further guidance of anatomic liver resection,it has a certain practical value in assisting R0 resection of primary liver cancer. |
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