| Part I Application of 64-MSCT technique in liver segments division and volume measurementObjective To explore the feasibility of 64-MSCT three-dimensional reconstruction technique in hepatic segments division and the volume measurement of the liver and various hepatic segments.Methods We selected 50 cases that underwent enhanced spiral CT examination of liver using GE 64-slice spiral CT scanner according to the inclusion criteria from October 2013 to December 2014 at the First Affiliated Hospital of Bengbu Medical College. All of the subjects were examined by triple-phase contrast-enhancement 64-MSCT and were applied for three-dimensional reconstruction by Advanced Workstation 4.4 software.On the basis of the vein and hepatic vein reconstruction out,to determine the scope of the hepatic segment based on the distribution of the portal vein and its branches and the boundaries of hepatic segments according traveling hepatic vein, then measured the volume of hepatic segments.Results The hepatic segments were divided clearly according to portal vein distribution,traveling hepatic vein and the important auxiliary signs including the liver natural groove,crack,fossa,ligaments and so on.The reconstructed images of the liver and hepatic segments were vivid,and the distribution and boundaries of the hepatic segments in the liver could be displayed and rotated clearly and accurately,the dividing line between the hepatic segments was irregular wavy lines.The liver volume and its surface area was highly positively correlated, the standardized liver volume were more rigorous.The difference of standardized livervolume and liver segments volume between male and female was not statistically significant.The standardized liver volume and hepatic segments volume of normal adults(not distinguish gender) as follows:the mean total liver volume was(764.91 ±78.28) cm3/m2,hepatic segments volume were:segment I(12.54±2.02)cm3/m2,segment II(84.63±9.01)cm3/m2,segment III(80.19±9.68)cm3/m2,segment IV(102.13±13.83)cm3/m2,segment V(126.17±12.98)cm3/m2,segment VI(97.38±16.41)cm3/m2,segment VII(109.67±15.39)cm3/m2, segment VIII(148.79±18.02)cm3/m2.The percentages of segment I to VIII were respectively(1.64±0.17)%、(11.19±1.95)%、(10.43±1.83)%、(13.36±1.27)%、(16.55±2.36)%、(12.69±2.67)%、(14.32±1.42)%、(19.45±2.37)%.Conclusion It was more accurate to display the liver and hepatic segments using the 64 MSCT by tracking the portal vein and hepatic vein branches.The reconstructed vascular tree,the liver and hepatic segments images were more vivid.The obtained statistics of liver and hepatic segments volume were applied to both men and women.This can provide guidance for liver resection, the preoperative assessment and surgical design of liver transplantation,and the course of liver disease.Part II The study of 64-MSCT three-dimensional reconstruction application in precise hepatectomyObjective To explore the value of 64-MSCT three-dimensional reconstruction technology in the preoperative assessment of liver resection and surgical program design and research the significance of relative residual liver volume in predicting postoperative liver function.Methods We collected 50 cases who were suffered from liver tumor and had an liver resection in Hepatobiliary Surgery from October 2013 to December 2014,in which 20 cases were test group who were performed preoperative assessment and designed surgery program accompanied by a hepatobiliary surgeon.The remaining 30 cases were chosen as a control group.Contrast the difference of blood loss and pringle time between the two groups.Measured liver volume, tumor volume and virtual resected liver volume and compared with the differences between virtual resected liver volume and actual liver resection volume,then evaluated the accuracy of three-dimensional reconstruction in liver volume measurement.The functional liver volume and relative residual liver volume were Calculated and the correlation between them were analyzed.Results The test group of 20 cases were successfully reconstructed the dimensional image of vascular tree, liver, tumor, virtual resected liver and remnant liver by three-dimensional reconstruction software,and in combination with other clinical data,preoperative evaluation and surgical program were designed.Each of 20 cases had successful surgery, and the preoperative surgical planning and the actual design were basically the same, no perioperative deaths.The comparison of the age, tumor volume, amount of bleeding, pringle timebetween test group and the control group was for independent samples T test,the difference between the two groups in age, tumor volume had no statistical significance,the amount of intraoperative bleeding, pringle time was less than in the control group, the P values were 0.031 and 0.025. The virtual resected liver volume measured by technique of 3D reconstruction were slightly larger than the actual hepatic resection volume, but they were highly positively correlated, the correlation coefficient r = 0.876(P < 0.001), by the independent samples T test, P value is 0.754, no statistically significant difference between the two groups.The risk factors analysis of liver damage was by univariate analysis and multivariate Logistic regression analysis.It came out that the operation time,intraoperative bleeding volume, remnant liver volume,relative residual liver volume were associated with postoperative severe liver function damage and the remnant liver fraction could independently forecast liver function damage.The correlation analysis for liver function damage and remnant liver fraction was by ROC curve,the critical value of remnant liver fraction was 33.5%, according to the remnant liver fraction,the patients were divided into two groups(%RLF≥33.5% and %RLF < 33.5%), the Fisher exact probability test, x2 = 6.408, P = 0.022, the difference between the two groups had statistical significance.Conclusion The use of three-dimensional reconstruction technique can reconstruct the 3D image of vascular tree, liver, tumor, virtual resected liver and remnant liver,which contribute to preoperative evaluation and operation program design and can effectively reduce intraoperative bleeding and the pringe time, these has very important guiding value in clinical treatment.Although the virtual resected liver volume measured by the 3D reconstruction slightly larger than the actual hepatic resection volume, there is a high positive correlation between the two,the difference was not significant.Therefore,the technique of 3D reconstruction can be widely applied to the measurement of liver volume,and can evaluate the remnant liver function.The operation time,intraoperative bleeding volume, remnant liver volume and relative residual liver volume were risk factors for severe liver function damage in patients after liver resection.The relative residual liver volune less than 33.5%,the incidence of severe liver function damage increased significantly,suggesting the relative residual liver volume measured by 3D reconstruction technology can effectively predict the risk of postoperative severe liver function damage. |
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