Application Of Three-dimensional Visualization To The Modified Right Hemihepatectomy

Objective:1.Under the guidance of three-dimensional visualization technology,the modified right hemihepatectomy?shifting the cross-section of the liver rightward about one centimeter based on the standard right hemihepatectomy?can meet the safety limit of liver resection for patients with primary liver cancer and cirrhosis by increasing the residual liver volume and retaining the hepatic artery blood supply of the residual right hepatic tissue.2.To evaluate the safety and efficacy of modified right hemihepatectomy by comparing the data such as the incidence of postoperative complications and survival prognosis between the two groups.3.To evaluate the accuracy of clinical precise hepatectomy guided by three-dimensional visualization technology by comparing the volume of reconstructed liver with the volume of the actual resected liver.Methods:44 patients with primary liver cancer and cirrhosis in our hospital were divided into control group?N₁=32 cases,standard right hemihepatectomy?and modified group?N₂=12 cases,modified right hemihepatectomy?according to the way of operation.The basic operation conditions?intraoperative bleeding volume,operation time and hospital time,etc?,liver function?alanine aminotransferase,total bilirubin,albumin?and postoperative complications?hydrothorax and ascites,biliary fistula,liver failure,etc?and prognosis and follow-up results were compared between two groups.In the control group,the data such as the left liver volume were measured retrospectively by three-dimensional visualization technique after operation.In the modified group,the data such as the left liver volume,virtual resected liver volume and residual liver volume were measured by three-dimensional visualization technique before operation,the difference between the actual resected liver volume measured by drainage method and the virtual resected liver volume was compared.SPSS 25.0 software was used to analyze the data.The quantitative data were expressed as mean±standard deviation?x±s?and compared with independent t-test.The enumeration data were expressed as rate?%?and compared with chi-square test.Paired t-test was used to compare the actual resected liver volume and the simulated resected liver volume,and Pearson correlation analysis was used to analyze the correlation.The cumulative survival rate curve was performed by Kaplan-Meier analysis with Log-rank test.The difference was significant when P<0.05.Results:1.Three-dimensional visualization technology can display the location,size and adjacent relationship of intrahepatic lesions,the direction and distribution of blood vessels,and the whole liver and other anatomical information.2.Modified right hemihepatectomy can resect the liver by shifting the resection line one centimeter to the right on the basis of the resection line of the standard right hemihepatectomy.Because of it,the percentage of residual liver volume can be increased from?34.8±1.6?%to?43.3±13.7?%.The increased residual liver volume?the reserved partial right liver tissue volume?is?104.5±13.2?%,ranged from 85ml to132ml,accounting for?8.5±1.1?%of the standard liver volume,ranged from 6.6%¹0.4%.3.There were significant difference?P<0.05?in hospitalization time and incidence of total complications between the two groups.There were no significant difference?P>0.05?in the left liver volume,intraoperative bleeding volume,operation time,recurrent and metastatic rate of tumor and survival curve between the two groups?P>0.05?.4.In the actual operation of the modified group,the extent of resection and the adopted method are basically consistent with those of three-dimensional reconstruction plan,there was no significant difference?P>0.05?between the virtual resected liver volume?696.3±79.8?ml and the actual resection liver volume?682.7±86.6?ml,with the Pearson correlation analysis?r=0.928,P<0.05?.Conclusion:1.Modified right hemihepatectomy can resect the liver by shifting the cross-section of the liver rightward about one centimeter based on the standard right hemihepatectomy.Because of it,the percentage of residual liver volume in patients with hepatocellular carcinoma and cirrhosis can be increased from?34.8±1.6?%to?43.3±13.7?%,which meeting the safety limit of hepatectomy.2.The modified right hemihepatectomy with preservation of the right hepatic artery is a new surgical method,which can effectively reduce the incidence of complications such as pleural effusion and ascites and recovery early after operation compared with standard right hemihepatectomy.3.Three-dimensional visualization technology has obvious clinical application value in preoperative virtual hepatectomy,measurement of liver volume,evaluation of surgical risk and optimization of surgical scheme and other aspects.