Application Of Computer-assisted Surgery In Hepatic Vein Classification And Pediatric Liver Tumor Resection

Part 1Clinical application of hepatic vein typing based on computer-assisted surgery systemObjective To conduct the typing of hepatic veins and measure the corresponding reflux liver volume,provide theoretic rationales for individualized anatomical hepatectomy based on computer-assisted surgery system and commit a big data analysis.Methods Thin-layer computed tomography(CT)imaging of 570 cases were reconstructed using Hisense CAS and typing of hepatic veins was analyzed with big data according to medical image variation.The margins of liver lobe and backflow volume were displayed automatically with hepatic vein branches.Results According to statistics,main hepatic veins were classified into three types ofⅠ(270/570,47.4%),Ⅱ(294/570,51.6%),Ⅲ(6/570,1%).LHV was classified into three types of Ⅰ(190/570,33.4%),Ⅱ(79/570,13.9%),Ⅲ(301/570,52.8%).MHV was classified into three types ofⅠ(313/570,54.91%),Ⅱ(174/570,30.53%),Ⅲ(83/570,14.56%).RHV was classified into three types of Ⅰ(456/570,80.0%),Ⅱ(79/570,13.9%),Ⅲ(35/570,6.1%).And type Ⅰwas classified into four subtypes of A(26/456,5.7%),B(404/456,88.6%),C(20/456,4.4%),D(6/456,1.3%).The LHV volume is(24.95±6.60)%,MHV volume(34.80±9.50)%.RHV volume is(25.14±11.60)% in 63 patients with inferior right hepatic veins(IRHV),and IRHV and other branches volume are(14.71±7.38)%.RHV volume is(40.68±8.61)% in 68 patients without IRHV.Conclusions Variations are complex for hepatic veins.The significant differences existed in hepatic venous reflux volume.Hisense CAS can clearly delineate the adjacent relationship of intrahepatic vascular and liver carcinoma and improve success rate of complex hepatectomy.Part 2Application of computer assisted surgical system in hilar tumor resection at the second hepatic portal area in childrenObjective The Hisense computer-assisted surgery system(Hisense CAS)was used to three-dimensional reconstructionfor for thin layer CT image in children liver,digtial model of liver was obtained.Analyse the relationship between liver tumors and hepatic veins in children,to explore the clinical value of computer-assisted surgery system in pediatric liver surgery.Methods The clinical data of 27 cases with liver tumors at the second hepatic portal area from January 2013 to June 2017 in the affiliated hospital of Qingdao University was analyzed.There were 19 male and 8 female patients aged from 2M to 10 years with average age of(2.3±2.9)years.Maximum diameter of tumor was 21.0cm and median diameter was 10.2cm.Before surgery,liver three-dimensional reconstruction by Hisense CAS were taken on all patients to observe the relational between intrahepatic vasculars and the liver tumor,and to calculate the intended resection range and the remaining liver volume in order to make a proper surgery plan.Intrahepatic vessel shape and variation,surgical operation,surgical operation time,blood loss,intraoperative blood transfusion,postoperative complications were observed.Results According to the preoperative three-dimensional reconstruction,there were 5cases with single main hepatic vein invaded by tumors,1 cases with two main hepatic veins,1 case with three main hepatic veins.There are 20 cases with main hepatic vein oppressed,of which 1 cases oppressed the inferior vena cava,and 1 cases had diffuse total hepatic lesion.Right hepatectomy was carried out in 11 cases and left hepatectomy was carried out in 3 cases.Left trisectionectomy was appplied in 3 patients.Mesohepatectomy was applied in 7 patients,and right anterior lobe resection was 3 cases.The average tumor volume(10.67*8.57*6.48)cm3,the average operation time 162min(60min-260min),the median blood loss 20ml(2ml-400ml),the average red blood cell transfusion 1.85U(0.1U-8U),and the average postoperative hospitalization was 10.2d(7d-14d).Postoperative pleural effusion occurred in 1 cases,and closed drainage was given to the pleural cavity.Conclusions Computer assisted surgery system can clearly and accurately display the relationship between liver tumor and hepatic vein in children,accurately evaluate the feasibility of surgery,and optimize the operation plan,which has important guiding significance for children with second hilar tumors.