| Aims:1.Reconstruction of intrahepatic vascular structures using three-dimensional reconstruction software of liver aims to analyze the types and rate of anatomical variation of hepatic vein,portal vein and hepatic artery;2.Preoperative three-dimensional reconstruction of the liver intents to explore the guiding significance of liver surgery of the adjacent relationship between the vessels and tumor;3.Reconstruction of the liver and tumor using the three-dimensional reconstruction software plans to evaluate the tumor resectability from the perspective of liver volume,reposition the tumor on the basis of three-dimensional space and make virtual surgical resection.It can formulate reasonable operation plan to guide the operation,and provide a reliable basis.Methods:Retrospective analysis patients with primary liver cancer from October 2015 to December 2017 in the hepticbile surgery at the Sino-Japanese Friendship Hospital of Jilin University,screening selected46 patients to meet the inclusion criteria as the subject of this study.The application of liver preoperative Myrian software was used to reconstruct the liver of CT images.The intrahepatic blood vessels,tumor location,size and the adjacent relationship between the two were analyzed.Thetype and rate of anatomical variation of intrahepatic blood vessels were calculated.The tumor was located and virtualized.TLV,SLV,FLV,Tu V,v RLV,v RSV,RLV and other data were recorded.The volume and weight of the resected specimens(a RSV and a RSW)were measured and their correlation with v RSV was analyzed.Statistics and analysis postoperative patients with liver damage and related complications.Results:Forty-six patients' images of the three-dimensional reconstruction for liver cancer using the Myrian software in our study were clear.The tumors were located in 18 cases of right hepatic,4 cases of hepatic lobe,16 cases of left hepatic hemangioma and 8 cases of other hepatic segments and irregular spaces.Myrian three-dimensional Reconstruction Software provides accurate,intuitive and clear images.It can obtain the accurate liver volume calculations,multiple virtual surgical procedures and assistance with surgical procedures.At the same time,the three-dimensional reconstruction software of liver can describe the anatomical structure of the hepatic arteries,hepatic veins and portal veins and the model of vascular remodeling.The multi-angle and individualized manifestation of normal anatomy and variant types of hepatic vessels.1.vascular reconstruction image analysis(1)Hepatic artery by Michels classification,37 cases of normal hepatic artery anatomy(80.4%),anatomical variation in 9 cases(19.6%).Among them,there were 2 cases of Michels ?,? and ?,the rates of variation were 4.3%,1 case of Michels ?,? and ?,respectively,the rates of variation were 2.2%.It was no found Michels ?,?,? andother special types of mutation.The right hepatic artery variability is more common in 46 cases respectively,the mutation rate was 10.9%.(2)According to the Nakamura classification,according to the diameter of the hepatic vein and the incidence of the right posterior vein,hepatic vein anatomical variant type ?,common type in 33 cases(71.7%),anatomical variant ? type in 8 cases(17.4%),Type ? in 5 cases(10.9%).(3)Portal vein in 35 cases(76.1%)were normal portal vein dissection according to Couinaud's and Atri's classification.There were 5 cases(10.9%)of type ?,4 cases of type ?(8.7%).Type ?: a total of 2 cases(4.3%).The total variability of portal vein was(23.9%),and no other special mutation types were found.2.liver volume calculation resultsThe average volume of total liver(TLV)was(1617.7±363.9)cm3,the average volume of tumor(Tu V)was(371.5±290.0)cm3,the average volume of virtual resection liver(v RLV)was(483.8±219.1)cm3,the averaged residual volume of liver(RLV)was(762.44±129.5)cm3 and the average volume of virtual resection specimen(v RSV)was(855.30±377.4)cm3.The average actual resection specimen volume(a RSV)was(892.3±352.2)cm3 and the average actual resection specimen weight(a RSW)was(958.3±366.7)g.Pearson test showed that the correlation between v RSV/a RSV,v RSV/a RSW and a RSV/a RSW was highly positive(r1 = 0.966,r2 = 0.980,r3 = 0.960,P <0.001).3 the impact of liver damage factors analysisUnivariate analysis of risk factors leading to liver damage during the perioperative period revealed that intraoperative blood loss,RLV,%RLV,and RLV/FLV were closely related to postoperative liver dysfunction.Theinfluence of these factors on moderate and severe hepatic dysfunction was analyzed by multivariate analysis.The results suggest that intraoperative blood loss,%RLV,and RLV/FLV are important in predicting the occurrence of postoperative moderate and severe hepatic dysfunction.Conclusions:(1)The three-dimensional reconstruction of liver can not only observe the type of vessels in the nutritional tumor,but also determine the adjacent relationship between the tumor and important blood vessels in the liver.At the same time,it can provide important information for the selection of the clinical treatment and the development of the surgical plan.Especially,for patients with important vascular anatomical variations and tumor infiltration,it can also provide the correct and objective information;(2)The three-dimensional reconstruction of liver has the important guiding significance for the precise surgical resection of liver cancer.The preoperative evaluation of liver function combined with the three-dimensional reconstruction of liver is of great help to tumor localization,automatic segmentation and quantitative analysis.Liver volume calculation and virtual liver resection are of great value for the possibility and thoroughness of surgical resection and the determination of a reasonable treatment regimen.It contributes to the prediction of postoperative liver dysfunction and guides the clinical treatment;(3)The three-dimensional reconstruction of liver Myrian software is simple,noninvasive and clear in image,which has important clinical significance in the field of liver surgery. |
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