| Objective1. To study the methods of three-dimensional reconstruction on liver and PV(portal venous),HV(hepatic venous),tumor based on CT scanning data,providing personal three-dimensional visualization model of liver in precise hepatectomy.2.To evaluate the clinical significances of preoperative virtual hepatectomy planning.3.To investigate the incidence of hepatic Dysfunction following liver resection in patients with hepatic tumor by calculating the residual liver volume.Materials and methods1.19 cases,who were suffered from liver tumor,were collected into this study from Mar.2009 to Dec,2010 in the NO.2 affiliated hospital of Guangzhou Medical College,14 cases was male and 5 cases was female. The oldest was 76 years and the youngest was 35 years,the average age was 55 (±11)years old. Underlying tumors were hepatocelluar carcinoma (n=15), metastases of colorectal cancer(n=1), hemangioma(n=1) , GIST(n=1). 6patients were exited this study for not measure the volume of resected liver.All patients,who were performed hepatectomy, were confirmed by surgical pathology.2. The CT scanning was performed with 64 slice CT in the second hospital of Guangzhou Medical College. All of the patients were examined by triple-phase contrast-enhancement CT by Germany's Siemens Sensation machine .All of the data was reconstructed in 2-mm section and 2-mm interval.And then the CT images of each patiens was burn to compact disc to save. Contrast agent used syringes single-phase high pressure injection, which injection rate is 4 ml/s . 3. All CT datas was imported into Myrian software and the three-dimensional reconstruction model was performed .The following steps were taken .First, image analysis and 3-D reconstruction; Second, virtual resection and liver volumetry;Third, computer-assisted risk analysis for the hepatic dysfunction after operation ,and adjustment of the operation planning. Functional liver volum,virtual resected liver olume,remnant liver volume were calculated automaticly by Myrian. Virtual resected liver volume were compared with the actual volume, which was measured by the method of water displacement after tumor resection.Results1.the 3D liver model with intrahepatic venous could be view from any angle on computer screen.The appearance of 3D lover model was good and smooth. Liver segment could be visualed with different colors.The intrahepatic vessels and tumors could be showed through the visualiztion technic.The virtual liver resection territory was identified according to adjacent relationship of the hepatic PV,HV and tumor in 3D space.2.The relationship between the plane of the actual liver resection and virtual liver resection was remarkable.3. Simulation showed higher correlation (r=0.893,P<0.05) between predicted and actual liver resection volume. Simulation showed correlation (r=0.854,P<0.05 ) between estimated liver resection volume and actual liver resection weight.Conclusions1.3-D visualization can show doctor 3-D information of the liver,it can benefits doctor to get more valuable information.3-D model of liver can make it more clearly to understand the anatomical structure and the inner hepatic vascular system of each patient, It has significantly valuation in precise hepatectomy.2. Preoperative surgical design establish the best plan of liver incision, it can preserve sufficient functional volum of residual liver as much as possible.3.Residual liver volume after virtual hepatectomy could be predicte the likelihood of severe hepatic dysfunction following hepatic resection.4. The application of hepatic 3-D model and virtual hepatectomy,using Myrian software,can provide the important preoperative reference for a valuable planning and intraoperative strategy of complex hepatectomy.It can improve the surgical successful ratio and safety.5. Hepatectomy must be kept in the hands of skilled surgeons, whatever intelligence degree of the systems they might inherit.6.Myrian was recommended as a hepatic tool for its convenience and efficiency. |
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