| Objective:In recent years,owing to the three-dimensional reconstruction of information production and the development of many industries,precise surgical concept gradually developed in the field of hepatobiliary,precision has gradually entered the era of liver resection.professor zhi-qiang huang and jia-hong dong also has pointed out that the patient who accept precise liver resection surgery get the best effect of rehabilitation.The purpose of this paper is to explore pros and cons of minimally invasive surgery combined precision surgical technique,and promote three-dimensional reconstruction technology and laparoscopic hepatectomy,to reduce intraoperative injury,improve the quality of operation,then accelerate the Postoperative rehabilitation.Methods:Our center and team has completed more than 1000 cases of laparoscopic liver resections since 1998.And three-dimensional reconstruction was applied in our hospital since 2014 to guide liver surgery.More than 100 cases have been completed.This aricle analyses 94 cases of laparoscopic right half and partial hepatectomies from January 2014 to August 2016.All experimental data include preoperative characteristics,operating time,type of hepatectomy,intraoperative complications,blood loss and transfusions,length of stay and so on.The purpose is to compare the influence of three-dimensional reconstruction between laparoscopic major hepatectomy and partial hepatectomies separately.Results:We divided those 94 patients into four groups,three-dimensional reconstruction combined with laparoscopic major hepatectomy,laparoscopic major hepatectomy,three-dimensional reconstruction combined with laparoscopic partial hepatectomy,laparoscopic partial hepatectomy.There is no significant difference in age,pathology,previous abdominal surgery and liver cirrhosis among these groups.But the ALT level exist differences between the three-dimensional reconstruction combined with laparoscopic major hepatectomy,and laparoscopic major hepatectomy groups.So is the ratio of sex in three-dimensional reconstruction combined with laparoscopic partial hepatectomy and laparoscopic partial hepatectomy.We also assessed the surgical difficulty score.In the groups of laparoscopic major hepatectomy,The score was 10.17±1.528 in the three-dimensional reconstruction group,which was no significantly difference with that in the control group(10.61±0.778;P = 0.07).So was the same in the groups of laparoscopic partial hepatectomy(5.73±1.849 in the three-dimensional reconstruction group vs 4.94±2.193 n the control group,P=0.598).We also assessed the vascular anomalies,such as the hepatic artery and portal vein,hepatic vein.Only 60.8%of patients had the normal anatomy.In the groups of laparoscopic major hepatectomy,The bloodloss was 475±263.3 ml in the three-dimensional reconstruction group,which was significantly less than that in the control group(972.21±811.5 ml;P=0.044).The conversive rate was 0%in the three-dimensional reconstruction group,which was significantly less than that in the control group(56%;P = 0.002).The results showed significant difference.In the groups of laparoscopic patial hepatectomy.The operating time was 172±45.4 min in the three-dimensional reconstruction group,which was significantly less than that in the control group(186.8±83.3 min;P = 0.014).The results showed significant difference.The intraoperative complications(Level Ⅲ and above level Ⅲ complications)was 0%in the three-dimensional reconstruction group and 27.8%in the control group(P=0.046)among the laparoscopic major hepatectomy patients.However,Postoperative indicators didn’t show significant different in laparoscopic patial hepatectomy group.Conclusion:In laparoscopic major hepatectomy,Preoperative three-dimensional reconstruction brought more benefits compared with those patients who were not line of three-dimensional reconstruction,with safety and effectiveness.But in partial liver resection,benefits brought by three-dimensional reconstruction was not very obvious. |
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