Application Of Three Dimensional Reconstruction And ICGR15 In Liver Resection

Objective:1. Evaluate the clinical application and value on 3D reconstruction system in patients with hepatocellular carcinoma(HCC) and hilar cholangiocarcinoma,discuss the accuracy, feasibility and the guidance to surgery of the system.2. Reconstruct the liver of the patients, who were diagnosed as HCC, by using the IQQA-liver system. Then make operation plan combined with the ICGR15 and other comprehensive examination before surgery. Monitor the ICGR15 of the residual functional liver in the operation. Discuss the application of ICGR15 combined with the IQQA-liver system in precise hepatectomy and the relationship between ICGR15 and postoperative recovery after liver resection.Method:Part one:Selected 54 cases of HCC and hilar cholangiocarcinoma patients treated by Tianjin First Central Hospital. Introduce the preoperative enhanced CT results into the three dimensional evaluation system, then formulate surgical plan. To compare the relationship between liver volume measured through three dimensional reconstruction and the real resected liver volume.Part two:Selected 43 cases of HCC patients treated by Tianjin First Central Hospital.Introduce the preoperative enhanced CT results into the three dimensional evaluation system, then formulate surgical plan combined with the ICGR15 and the other comprehensive examination before surgery. Monitor the ICGR15 of theresidual functional liver in the operation. Divide the patients into two groups according to the recovery of liver function after operation, analysis the differences of the indicator data between the two groups were.Result:Part one:Liver volume of hilar cholangiocarcinoma was(1008±528)ml, HCC was(761±337)ml measred by three dimensional reconstruction.The real resected liver volume of hilar cholangiocarcinoma was(742±370)ml, HCC was(850±410)ml.Liver volume of all patients measred by three dimensional reconstruction was(853±425)ml, and he real resected liver volume was(742 ± 370)ml. There was no statistical differences between the two quantitative value(t=0.582,P=0.562).Part two : Between liver function recovery group(29 cases) and hepatic decompensation group(14 cases),operative time,blood loss,TBIL,ALT,liver resection rate had no significant difference(P > 0.05). But SRLVR, ICGRl5 and R were statistically significant(P < 0.05).R was the best index for forecasting recovery of liver function. The R cutoff value was 1.781(sensitivity 86.2%,specificity 86.2%).The R was significantly related with blood loss,ACHE, SRLVR.And SRLVR was an independent influencing factor.Conclusion:Part one:The three dimensional evaluation system, we can intuitivly and accurately observe liver lesions and adjacent relationship. At the same time,we can simulate surgery,guiding the actual surgery.Part two:ICGRI 5 combined with three dimensional evaluation system can predict the recovery of liver function after operation. R<1.781 can be the boundarie of liver function prediction index. And SRLVR was an independent influencing factor.