| Objective 1.Three-dimensional(3D)reconstruction technique was used to perform preoperative 3D reconstruction,volume measurement and simulated operation for advanced hepatocellular carcinoma(HCC)beyond standard Milan criteria.The individualized operation scheme was established to explore the application value of 3D reconstruction technique in guiding hepatectomy of advanced HCC beyond standard Milan criteria.2.Tumor volume,spleen volume and residual liver volume measured by 3D reconstruction were analyzed about their effects on prognosis of advanced HCC.3D reconstruction was also discussed about its application on predicting prognosis of advanced HCC.Methods Part I: Twenty patients with advanced HCC with high risk of resection under the traditional preoperative evaluation system were selected from hepatobiliary surgery in our hospital.Tumors involved in this study were beyond the standard Milan criteria.The results of enhanced CT before operation were introduced into the imaging analysis system for 3D reconstruction.Using the virtual surgery program to test different surgical schemes and calculate the real-time liver volume to screen and optimize the different surgical schemes.Finally,the most suitable individual operation plan was formulate to guide the clinical operation.Part II: The clinical and pathological data of 31 patients undergoing hepatectomy in our hospital from January 2014 to January 2017 were retrospectively analyzed.According to whether the patients recurred within one year,they were divided into recurrence group(N=17)and non-recurrence group(N=15).23 factors including tumor volume,spleen volume,residual liver volume,etc.which may affect the postoperative recurrence were analyzed in the study.The follow-up results and clinical data were analyzed by univariate Logistic regression analysis with SPSS 17.0 software.The multivariate Logistic regression analysis was carried out on the statistically significant factors.The ratio of AFP value to tumor volume and the ratio of spleen to residual liver volume were analyzed by ROC analysis.Results Part I: All of the 20 patients underwent 3D reconstruction successfully.The intrahepatic vascular structure was clear,and could rotate at any angle.The relationship between tumor and vascular trunk and its branches,as well as the compression and invasion of blood vessel were observed clearly.The hepatectomy was performed in 16 patients successfully guided by the simulation operation.The coincidence rate between the operation and the preoperative 3D reconstruction was 100%(16/16).According to the results of 3D reconstruction,the operation plan is formulated.The actual operation process is in accordance with the preoperative operation planning rate of 100%(16/16).No major vessels were injured during the operation and no perioperative death cases were found.Postoperative biliary fistula occurred in 1 cases and the wound fat liquefaction was found in 2 cases,which was improved after symptomatic treatment.All the patients were discharged.Part II: Univariate analysis showed that number of tumors,tumor clinical stage,lymphovascular invasion,microvascular invasion(MVI),The ratio of AFP value to tumor volume and tumor volume were the key factors of tumor recurrence.The results of multivariate analysis show that the ratio of AFP value to tumor volume and MVI were the independent risk factors of recurrence.The results of ROC analysis showed that the ratio of AFP value to tumor volume was one of the prognostic factors of advanced HCC beyond standard Milan criteria,and the risk of recurrence was higher when the ratio was more than 2.2.Conclusions Part I: 3D reconstruction system can simulate and reconstruct the shape of liver and tumor and structure of intrahepatic vascular in advanced HCC beyond standard Milan criteria.The system can determine the location of tumor,the adjacent relationship between tumor and important blood vessels,accurately measure the volume of each part,simulate operation and predict the resection range.It can play a guiding role in the preoperative planning.Part II: 3D reconstruction plays an important role in assessment of prognosis of advanced HCC beyond standard Milan criteria.For the patients whose ratio of AFP to tumor volume is greater than 2.2,they should enhance postoperative follow up,and formulate strengthening surveillance way to precaution the liver cancer recurrence. |
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