Dynamic Analysis Of Liver Volume Change After Hepatectomy Based On Three-dimensional Imaging Technique

Part 1 Verify the accuracy of 3D simulated removal of liver volumeMaterials and Methods:Object According to the inclusion and exclusion criteria,241 patients in the Third Department of Hepatic Surgery of the X Hospital of Navy Military Medical University who underwent hepatectomy for liver neoplasms between October 2016 and April 2017 were enrolled.Aims Verify the accuracy of 3D simulated removal of liver volumeMethods Retrospective analysis of 241 patients with liver neoplasms undergoing liver resection in our department.All subjects(241 patients)underwent enhanced CT examination before surgery.CT original DICOM format data was input into Yorktal Digital Medicine Software.Compared the liver specimens volume measured by the three-dimensional imaging technique and the drainage method.Verify the accuracy of 3D simulated removal of liver volume.Preoperatively,the three-dimensional imaging software was used to develop a simulated resection plan,and the simulated resected liver volume was calculated.Intraoperatively,the liver specimens volume was measured using the drainage method.The statistical method used Bland-Altman analysis,linear correlation analysis and intra-group correlation coefficient.Results: Among the subjects,148(61.4%)were male and 93(38.6%)were female;the median age was 51 years(25-73 years);the median height was 166 cm(150-184 cm);the median weight was 71 kg(40-95kg),preoperative liver function Child-Pugh grade A 239 cases,B grade 2 cases;tumor pathological type was liver primary malignant tumor mainly(228 cases).Linear correlation analysis showed that there was a significant correlation between the three-dimensional simulated resected liver volume and the intraoperative specimen liver volume(correlation coefficient r=0.983,p<0.01),the intraclass correlation coefficient(ICC=0.982,p<0.01),the Bland-Altman analysis showed that only 4.98%(12/241)of the points were outside the 95% consistency limit,and there was good agreement between the two variables.Conclusion: There is a significant correlation and good consistency between the simulated resected liver volume planned by the three-dimensional imaging technique and the resected liver volume measured by the drainage method.It can be considered that the simulated resected liver volume planned by the three-dimensional imaging technique is accurate.Part 2 Dynamic analysis of liver volume change after hepatectomy based on three-dimensional imaging techniqueMaterials and Methods:Object The study was based on the “cohort of patients in the Third Department of Hepatic Surgery of the X Hospital of Navy Military Medical University”.The subjects were consecutively enrolled by non-probability sampling(judgment sampling)and enrolled according to the criteria for inclusion and exclusion.In the end,234 patients were included in the cohort study,and all subjects signed the informed consent document.Aims Using three-dimensional imaging technology to measure the liver volume of patients in different periods,dynamically observe the changes of liver volume caused by liver regeneration after partial liver resection in different patients.Analyze the effects of individualized factors such as age,gender,removal liver volume and degrees of liver fibrosis on liver regeneration.Analyze the relationship between early liver function recovery and liver regeneration after hepatectomy,and the results were used to guide clinical work.Methods In this study,a single-center,prospective cohort was conducted.Sample size estimation and independent variable selection were performed based on pre-experimental results,literature search and clinical experience.Finally,234 subjects were included in the cohort.The three-dimensional imaging technique was used to calculate the liver volume at various times,and the liver regeneration indices(RI)was calculated.The single-factor repeated measures ANOVA was used to analyze the volume change trend of liver after hepatectomy.Two independent samples t-test and covariance analysis were used to analyze the differences of RI between groups with and without hepatic fibrosis.Multiple linear regression analysis was used to analyze the factors affecting RI7,Independent sample t-test was used to analyze the relationship between postoperative liver function recovery and liver regeneration indices.Results: The "Hepatic Regeneration Research Cohort" was enrolled in 234 patients,154 patients with liver fibrosis,and 80 patients with non-fibrosis.The resection parenchymal liver rate(Re PLR)was 22.7%(± 11.7%).The liver volume increased rapidly one week after hepatectomy and decreased from one week to one month after surgery.The liver volume gradually increased from the first month to the third after surgery.The difference was statistically significant.Non-fibrosis patients had a faster increase in liver volume within one week.The liver volume decreased from one week to one month after surgery,and there was no significant difference between the two groups.The liver volume increased slowly in the third trimester,and there was no significant difference between the two groups.The two-factor repeated measures ANOVA showed the same trend of postoperative liver volume change in two groups.One-way covariance analysis showed that after adjusting the remnant liver volume RLV0,the difference of RLV7 was statistically significant.There was a statistical difference in RI7 and RI30 between the two groups.RI90 was not significantly different between the two groups.The difference in RIX among the larger resection group and the smaller resection group was statistically significant at 1 month and 3 months after surgery.In the liver fibrosis group,there was a statistically significant difference in RI7 among the larger resection group and the smaller resection group.In the non-fibrotic group,RI7 was no statistical analysis between the large resection group and the small resection group.Multiple linear regression analysis showed that remnant liver volume rate(RLVR),preoperative antiviral,preoperative serum albumin(ALB),body weight had a significant effect on RI7.There was no significant difference in RI7 between the liver function recovery group and hepatic dysfunction group(P=0.228),and RI30 and RI90 were statistically different between the two groups(P=0.010,P=0.019).Conclusion: Liver volume increases rapidly one week after surgery and decreases from one week after surgery to one month after surgery.The liver volume gradually increases from the first month to the third month after surgery.Liver fibrosis has an effect on the degree of liver regeneration within one month after surgery,but the effect on later liver regeneration is not obvious.Resection parenchymal liver rates has a greater impact on postoperative liver regeneration,especially in patients with liver fibrosis.Multivariate analysis showed that the more liver remaining in surgical resection,the less liver regeneration after surgery,and the lower preoperative ALB means lower degree of liver regeneration after surgery.Antiviral therapy will be beneficial to the patient’s postoperative liver regeneration.For patients with heavier weight,the regeneration after liver surgery may be adversely affected.In addition,the liver volume change in one week after surgery is not parallel to the recovery of liver function.