| Purpose In the 21 st century,Liver surgery enter the era of precise hepatectomy.Precise hepatectomy has higher requirements for image data in preoperative evaluation.Traditional CT examination plays an important role in liver surgery.On the basis of plain scans,enhancement scans are performed.It plays an important role in finding the locations of lesions,identifying the nature of lesions,and assessing the condition of blood vessels in the liver.However,traditional CT examinations cannot provide intuitive,stereoscopic,visual,and operative liver imaging data,and it is impossible to perform simulated hepatectomy,surgical planning,and accurate calculation of the remaining liver volume.Relying on traditional CT,the design of the preoperative surgical plan completely depends on the transformation of the two-dimensional image data in the surgeon's mind,and is completed with the aid of the doctor's experience and analytical judgment ability.This situation will affect the surgical effect to a certain extent.With the application of digital imaging technology in liver surgery,this new image technology that converts two-dimensional image data into three-dimensional image data and has operability remedies the shortcomings of traditional CT and shows promise in liver surgery.This study used the INCOOL 3D precision surgical planning analysis system for preoperative analysis of hepatectomy to evaluate the application value of the 3D precision surgical planning analysis system in hepatectomy.The statistical analysis of the surgical planning analysis system and CT imaging or the actual different conditions in the surgery were performed,and the application of surgical planning analysis system and intraoperative ultrasound in hepatectomy was compared.In order to provide some guidance for the application of 3D precision surgical planning and analysis system in hepatectomy.Methods Inclusion of 23 patients scheduled for liver resection in Hepatobiliary and Pancreatic Surgery of Wuhan Central Hospital from May 2017 to February 2018.All patients had improved biochemical tests such as routine blood tests,hepatorenal function,and tumor markers before surgery.At the same time,64 rows of CT plain scans and enhancements were performed.Grouping situation: the control group only performed CT plain scan + enhancement before surgery,and no surgical planning analysis was performed.Routine surgical treatment was performed based on the CT findings.In the experimental group,12 cases were performed CT plain scan + enhancement before operation,and the surgical planning analysis system was used at the same time.Surgical treatment was performed by the same team after surgical analysis and planning.The CT is a 64-slice spiral CT from Toshiba Corporation of Japan,image storage system is PACS,image storage format is DICOM,and the surgical planning system is the INCOOL 3D precision surgical planning analysis system of Hangzhou Yingku Medical Technology Co.,Ltd.Data Analysis Software is SPSS 22.0.Statistical method: Gender,surgical methods(represented by the number of resected liver segments),and complications were analyzed by Chi-square test.Age,Operation time,Blood loss,Length of hospital stay were analyzed by T-test.Comparing Preoperative Planning of Hepatectomy Volume and Actual Hepatectomy Volume of 3D Precise Planning System.Comparing the accuracy of preoperative vascular invasion between 3D precision surgical planning system and conventional 2D CT images.Comparing the difference in the detection rate of small lesions in the liver between the 3D precision surgical planning system,traditional 2D CT images and intraoperative ultrasound.Results The CT scan and enhanced image data were obtained in both experimental group and the control group.In the experimental group,three-dimensional reconstruction of CT image data was performed to generate three-dimensional simulated images.The relationship between lesions and intrahepatic vasculature was analyzed and virtual hepatectomy was performed.The best surgical plan was established by comparing different simulated resection plans.Hepatectomy was performed according to the final surgical planning results.There were 11 patients in the control group,5 males and 7 females,with an average age of 54.73±8.65 y.The experimental group consisted of 6 males and 5 females with an average age of 53±11.85 y.There was no statistical difference between genders(P=0.536)and age(P=0.692)in the control and experimental groups.In the experimental group,the number of surgically resected hepatic segments was 1 in 4 patients,2 in 2 patients,3 in 3 patients,and 5 in 2 patients;in the control group 1 in 3 patients,2 in 3 patients,3 in 2 patients,4 in 1 patients,5 in 2 patients,there was no significant difference in surgical approach between the experimental group and the control group(P=0.611).The operative time was(204.55±46.55)min/(247.27±51.79)min(P=0.015),intraoperative blood loss(199.09±74.89)ml/(261.82±60.63)ml(P=0.044)in the experimental group and the control group.Statistical differences(P<0.05).The operation time of the experimental group was shorter than that of the control group.The blood loss in the experimental group was less than the control group.The postoperative complications of the experimental group and the control group were 9.09%/18.18%(P=0.534),and the length of hospital stay(12.73±2.49)d/(12.18±2.18)d(P=0.591)was not statistically different(P>0.05).Virtual liver resection was performed in the experimental group and the volume of resection liver and remaining liver volume were calculated automatically.The volume of resected specimens was measured after surgery.The preoperative planning and actual resection of liver volume were compared.There was no significant difference between preoperative planning results(637.97±817.18)ml and actual postoperative resection results(618.40±766.83)ml(P=0.957,P>0.05).In the experimental group,6 vascular invasions were actually confirmed.6 vascular invasions were confirmed by preoperative planning systems,the compliance rate is 100%.The control group actually confirmed 7 vascular invasions.4 vascular invasions were confirmed by preoperative CT scans,the compliance rate is 57.1%.There was no statistical difference between the experimental group and the control group in determining vascular invasion(P=0.067).In the experimental group,1 patient with intraoperative ultrasound unexpectedly discovered multiple small nodular lesions,but thepreoperative CT and surgical planning systems did not show the corresponding lesions;3 patients in the control group had unexpected small lesions during intraoperative ultrasonography;the results of preoperative CT examination were not display.In general,intraoperative ultrasound was significantly superior to CT examinations and surgical planning systems in the detection of small intrahepatic lesions.In all patients,the pathological results of patients diagnosed with liver tumors were hepatic carcinoma,patients diagnosed with intrahepatic bile duct stones were intrahepatic bile duct stones with hepatic fibrosis,patients diagnosed with liver portal occupational lesions were hilar cholangiocarcinoma.Conclusion Using three-dimensional reconstruction technology to generate three-dimensional virtual models on the basis of traditional CT image data,using surgical planning system for preoperative planning analysis helps to develop the optimal surgical plan.Compared with the traditional CT image data,the surgical planning system can more intuitively and accurately understand the lesion and the intrahepatic anatomy,making the purpose of liver resection more effective,more accurate,and effectively shorten the operation time and reduce the amount of blood loss.However,because the three-dimensional virtual model data of the surgical planning system is derived from CT image data,it is impossible to completely avoid the insufficiency of the CT in terms of the resolving power.In addition,in the actual operation process,there are different accidents or even unexpected situations with the surgical planning system.Despite the advanced 3D imaging technology,the experience and skills of surgeons are still the most important factors determining the success of liver resection. |
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