| Objective:To investigate the clinical value of Hisense Geminl 3-D Medical Imaging Reconstruction and Computer Assisted Surgery System（Higemi-3DR&CAS）in precise anatomic hepatectomy for primary liver cancer（PLC）.Methods:In the Department of hepatobiliary surgery of Sichuan Provincial People’s Hospital from July 2015 to April 2016,the patients who were diagnosed as PLC were selected as study subjects and 52 patients who met the study criteria and exclusion criteria were selected as the observation group.The preoperative application of Higemi-3DR&CAS to 3D reconstruction,preoperative evaluation and surgical simulation planning can guide clinical precise anatomic hepatectomy,the postoperative pathology was confirmed as PLC.According to the factors of“Couinand”segmental anatomy of liver,the difficulty of the surgical resection of PLC and resection planes among hepatic segments,the cases of the observation group will be divided into three categories as right hemi liver area,left internal lobe area and left lateral lobe area that bases on the type of surgery and where the tumor region in anatomic resection.The clinical data of patients in our hospital from March 2014 to June2015（before the application of Higemi-3DR&CAS）who underwent the preoperative conventional two-dimensional image planning surgery,without the guidance of Higemi-3DR&CAS but also had performed anatomic hepatectomy of PLC were extracted by electronic patient system as the historical control group.78 patients who were 1.5 times matched with the medical history data can be regarded as the control group.Comparative analysis:（1）The effect of 3D reconstruction of the liver in the observation group was compared with the actual operation condition in the operation;)2(The Observation group applied Higemi-3DR&CAS to analyze the liver volume.At the same time,the method of 2D-CT was used to measure the total liver volume,remnant liver volume and predicted resection volume.The difference between the two methods was compared and Correlation analysis was made between predicted resection volume and actual volume of the specimen;（3）The differences of the operation time,the time of hepatic portal occlusion,the intraoperative blood loss and blood transfusion between the observation group and the control group were compared.Results:The general clinical data of the two groups were comparable.1.The visual 3D liver model reconstruction,preoperative evaluation and simulation operation planning was successfully completed in the observation group.The preoperative analysis of the anatomical structure of the liver 3D model,the simulated resection condition and the intraoperative judgment are basically the same.The coincidence rate of the simulated operation and the actual operation was 98.1%,and the coincidence rate of the preoperative assessment of the blood vessel and the actual blood vessel was 100%.2.Volume analysis:The standard liver volume of the observation group was（1179±90）ml.CT measurement of total liver volume was（1304±264）ml.Higemi-3DR&CAS measurement of functional liver volume was（1145±214）ml,tumor volume was（197±122）ml.Specimen volume was（584±224）ml.The remnant liver volume and the predicted resection volume of the observation group which were measured through 2D CT method and Higemi-3DR&CAS method were（575±218）ml,（589±243）ml and（729±207）ml,（754±195）ml respectively,two methods had no difference（P>0.05）;There was a significant positive correlation between the predicted resection volume and the resected specimen volume of the two methods（r1=0.990,r2=0.992,P<0.001）.The error rate of Higemi-3DR&CAS which measured the predicted resection volume（5.1±3.7）%was less than the 2D CT measurement（2.5±5.5）%,but there was no statistical difference（P>0.05）.3.The aspects of the operation time,the time of hepatic portal occlusion,the intraoperative blood loss and blood transfusion.The operation time and the hepatic portal occlusion time of the observation group cases of right hemi liver area was shorter than that of the control group,the results respectively were（249.8±63.9）min and（296.4±56.3）min,（21.4±6.0）min and（30.8±8.4）min,P<0.05,there was no difference in the intraoperative blood loss,respectively（310.0±204.1）ml and（423.0±264.2）ml,P>0.05;The operation time,the hepatic portal occlusion time and the intraoperative blood loss of the observation group cases of left internal lobe area was better than that of the control group,the results respectively were（271.9±43.4）min and（323.8±57.0）min,（27.1±2.9）min and（35.2±5.0）min,（406.3±159.1）ml and（583.3±196.9）ml,P<0.05;And left lateral lobe area cases of liver segment resection of above indexes had no difference,respectively were（168.2±21.8）min and（161.0±32.7）min,（15.6±2.5）min and（17.1±3.7）min,（207.9±71.2）ml and（213.8±87.5）ml,P>0.05.The intraoperative blood transfusion rate and intraoperative blood transfusion volume of the observation group and the control group respectively were 13.5%,14.1%and（500±173）ml,（450±147）ml,there was no difference between the two groups（P>0.05）.Conclusion:1.The Higemi-3DR&CAS can reconstruct the real,objective and visualization of the 3D liver model,it accurately provides important anatomic information such as the morphology of liver,intrahepatic ducts and branches,tumor location and the relationship with the space position of peripheral vessels and so on.Volume analysis and simulated resection can provide an important reference for the preoperative accurate assessment and surgical planning,providing a digital guide for the precise resection of liver cancer.2.Although Higemi-3DR&CAS and 2D-CT have no significant difference on the liver volume analysis,Higemi-3DR&CAS 3D model in operation,visualization and interactivity is more convenient and efficient,it’s easy to master for the clinician and have a better clinical application value.3.Precise anatomic hepatectomy for PLC undergo Higemi-3DR&CAS operation planning in right hemi liver area can reduce the operation time and the time of hepatic portal occlusion;in left internal lobe area can reduce the operation time,the time of hepatic portal occlusion and the intraoperative blood loss.But for the left lateral lobe area anatomical resection does not have obvious advantages.Higemi-3DR&CAS can’t reduce the intraoperative blood transfusion. |
