| [Objective]To explore the correlation between the pre-resection liver volume obtained by the 3D reconstruction evaluation and the actual resected liver volume,and the clinical efficacy of the precise anatomical liver resection guided by the 3D visual reconstruction technology in the treatment of hepatocellular carcinoma.[Methods]31 patients with hepatocellular carcinoma who were admitted to department of general surgery of Baoan district central hospital in Shenzhen and department of hepatobiliary and pancreatic surgery of Shenzhen Second People’s Hospital from January 2016 to March2020,were selected as the observation group.All 31 patients received enhanced CT examination before surgery.Thin-layer CT image data were collected,and three dimensional visualization reconstruction technique was performed by the three-dimensional visualization system(Mimics Medical 21.0).The possibility of surgical resection was evaluated and simulated surgery was performed before surgery.Total liver volume,tumor volume,pre-resected liver volume and residual liver volume were calculated respectively.The specimen was weighed after resection and compared with the volume of pre-resection liver.The control group included 45 patients with hepatocellular carcinoma who did not undergo 3D reconstruction before surgery during the same period.The surgical effects and follow-up of the two groups were statistically analyzed.[Results]1.There were no significant differences in mean age,gender composition ratio,liver function index,Child-Pugh score,BMI,abdominal circumference,systolic blood pressure, diastolic blood pressure,fasting blood glucose,lipid index,tumor size and number of tumors between two groups(P>0.05).2.In the observation group,the tumor volume,total liver volume,standard liver volume,expected residual liver volume,residual liver volume ratio,residual liver volume and residual liver volume/total liver volume of 31 patients were(119.3±16.3)ml,(1215.6±78.3)ml,(1198.7±65.9)ml,(807.2±45.2)ml,(82.12±4.32)%,(800.2±43.9)ml,(81.87±5.45)%.The actual volume of liver resection was(415.8±22.9)ml,while the volume of liver resection simulated by 3D visualization before surgery was(429.3±20.6)ml,and the difference was not statistically significant(t=0.445,P>0.05).There was a remarkably positive correlation between ALV and PELV(AELV=0.97×PELV+18.36;r=0.980).PELV was consistent with ALV(ICC=0.998).3.The operation time of observation group was shorter than that of control group(203.6±24.6min vs 279.3±30.1min;t=20.369,P<0.01),the amount of intraoperative blood loss in the observation group was lower than that in the control group(294.7±26.8ml vs441.9±37.4ml;t=41.487,P<0.01),the amount of intraoperative blood transfusion in the observation group was lower than that in the control group(316.2± 45.8m L vs597.3±61.2ml;t=37.824,P<0.01).4.After surgery,TBIL,ALT and AST levels in both groups were increased significantly,but the control group was significantly higher than that of the observation group,and the difference was statistically significant(P <0.05).5.The length of stay and hospitalization cost in the observation group were significantly lower than those in the control group(P<0.05),and there were no significant differences in cancer metastasis rate,one-year postoperative survival rate and recurrence rate between the two groups(P>0.05).In the control group,there were 3 cases of pleural effusion,1case of abdominal effusion and 1 case of deep vein thrombosis of lower limb(peripheral).There was 1 case of abdominal effusion after operation in the observation group.The incidence of postoperative complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).The complications were discharged after symptomatic intervention,with no impact on the treatment process and the patients’ health.6.After surgery,CRP,TNF-α and IL-6 were significantly higher than that before treatment(P <0.05),and moreover,CRP,TNF-α,and IL-6 were significantly lower in the observer group than in the control group(P <0.05).7.The physiological,psychological,social and environmental scores of patients in the observation group were significantly better than those in the control group(P<0.05).[Conclusion]1.The expected excised liver volume obtained from the 3D reconstruction evaluation showed a significantly consistent correlation with the actual resected liver volume.2.The application of 3D visualization reconstruction technique can make preoperative evaluation and surgical planning conveniently,quickly and accurately,allow surgeon to perform fine operations during the operation,reduce intraoperative bleeding,avoid perioperative blood transfusion and reduce surgical complications,which is conducive to improve the safety and effectiveness of surgical treatment of hepatocellular carcinoma as well as the prognosis and quality of life of patients. |
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