Application Of Three-Dimension Imaging Technology With64-Slice Spiral Ct To Hepatectomy Of Liver Tumor

Objective:Nowadays surgical resection of hepatoma is still the best way for liver tumors. However, it is not easy to perform a hepatectomy for a surgeon of hapato-biliary surgery(HBS) due to various conditions, such as a complex anatomy of the liver, an abnormal vascular structures or a huge tumor close to porta hepatis and to some vital vessels, e.g portal vein, hepatic vein and inferior vena cava. Facing these situations mentioned above, it is difficult to understand a precise stereo-picture of tumor and its adjacent structures of the liver by2-dimentional (2-D) CT for even an experienced surgeon of HBS. As the three-dimentional(3-D) reconstruction technique at present can clearly show a stereo-picture of a liver tumor and its relationship with surrounding tissues, e.g. hepatic artery, portal vein and hepatic vein, in this study, we investigate the clinical value of3-D imaging technology with64-slice spiral CT in pre-operative assessment of patients undergoing a hepatectomy due to liver tumor to evaluate the safety and practicability of this technique in liver surgery.Methods:Pre-operative stereo-pictures of liver tumor and hepatic vessels were obtained by3-D imaging technology with64-slice spiral CT in23patients who underwent hepatectomies with different liver diseases. According to the information gained by this technique, the reasonable surgical procedures were selected and the pre-operative imaging data were combined with the final intra-operative findings to evaluate the preoperative efficacy.Results:The third branches of hepatic artery and portal venin, including the corresponding hepatic vein were clearly demonstrated by64-slice spiral CT3-D imaging technology in all cases. In addition,3-D reconstructive technique provided an accurate stereo-picture of tumor location as well as its relationship to hepatic vessels and surrounding structures, especially the artery supplying the tumor can be easily found, even the right sub-diaphragm artery to a huge liver tumor was shown in one case. Moreover, portal vein tumor thrombus (PVTT) in patients with HCC were also observed clearly, including the exact site, length and cross sectional area of PVTT by3-D imaging technology. All information about the stereo-picture of tumor acquired from the technology pre-operatively were identical with the intra-operative findings. These patients had good postoperative courses without complications.Conclusion:It has been suggested from this study that liver tumor and its relationship with liver vessels and adjacent structures can be accurately demonstrated by3-D reconstruction technique pre-operatively, which is of significances for a surgeon to establish a safe and reasonable route to make tumor resection and of practical value in liver surgery clinically.