Clinical Application Of Digital Medical 3D Visualization In Hilar Cholangiocarcinoma Surgery

Objective:To explore the clinical application value of digital medical 3D visualization technology in the operation of hilar cholangiocarcinoma.Method:The clinical data of 73 patients with hilar cholangiocarcinoma treated in hepatobiliary surgery of the Second Hospital of Hebei Medical University from June 2015 to December 2018 were retrospectively analyzed.Patients were randomly divided into observation group and control group according to whether 3D visualization technology was used before operation.The observation group consisted of 32 patients,including 20 males and 12 females,with an average age of 62.63±8.70 years,12 patients with preoperative yellow reduction,and 12 patients with preoperative three-dimensional reconstruction for surgical evaluation and planning.There were 41 patients in the control group,including 27 males and 14 females,with an average age of 61.76±8.04years,16 patients with preoperative yellow reduction,and 16 patients with preoperative CT imaging data were evaluated and planned for surgery.Firstly,all patients underwent thin-slice enhanced CT scanning of the upper abdomen before operation.The two-dimensional CT image data collected by the observation group were stored in DICOM form and then imported into Xudong IPS-3D Liver hepatobiliary 3D visualization system.The two-dimensional CT examination data of the patients were segmented and reconstructed.After 3D visualization of reconstructed images,the location of tumors was observed,the three-dimensional relationship between tumors and intrahepatic bile ducts,hepatic arteries,hepatic veins and portal veins was determined,Bismuth-Corlette typing was performed,the invasion of portal veins and hepatic arteries was evaluated,and the surgical plan was formulated and the operation was simulated.The accuracy of preoperative evaluation of clinical classification,portal vein and hepatic artery invasion was compared between the observation group and the control group.The operation mode,operation time,intraoperative bleeding volume,hospital stay,hospitalization expenses and the incidence of complications were recorded,and the differences of intraoperative and postoperative indicators between the two groups were compared.Result:1.Preoperative assessment:The accuracy of Bismuth-Corlette typing for hilar cholangiocarcinoma was 96.9%(31/32)in the observation group and80.5%(33/41)in the control group.The accuracy rate of Bismuth-Corlette typing in the observation group was higher than that in the control group(96.9%>80.5%)with statistical significance(X~2=4.47,P=0.04);the accuracy rate of portal vein invasion assessment in the observation group was90.6%(29/32),the accuracy rate of hepatic artery invasion assessment was87.5%(28/32),and the accuracy rate of portal vein invasion assessment in the control group was 82.9%(34/41),and hepatic artery invasion.The accuracy rate of criminal assessment was 85.4%(35/41).The accuracy rate of portal vein invasion assessment in the observation group was higher than that in the control group(90.6%>82.9%)and hepatic artery invasion assessment was higher than that in the control group(87.5%>85.4%),but there was no significant difference(X~2=0.90,P=0.34;X~2=0.07,P=0.79).2.Intraoperative condition:The average operation time of 32 patients in the observation group was 340.56±55.45 minutes,and the average intraoperative bleeding volume was 506.88±270.10 ml;the average operation time of 41 patients in the control group was 378.71±72.96 minutes,and the average intraoperative bleeding volume was 642.20±263.40 ml.Statistical analysis showed that the bleeding volume and operation time in the observation group were less than those in the control group,and the difference was statistically significant(t=-2.45,P=0.02;t=-2.15,P=0.04).3.Postoperative conditions:in the observation group,there were 2 cases of biliary fistula,1 case of reoperation after operation,1 case of hepatic failure,2 cases of incision infection,1 case of pulmonary infection,and the incidence of complications was 21.88%.In the control group,there were 4 cases of biliary fistula,2 cases of reoperation after operation,3 cases of liver failure,2cases of incision infection,2 cases of pulmonary infection,and the incidence of complications was 31.71%.Statistical analysis showed that the incidence of total complications in the observation group was lower than that in the control group,but there was no significant difference(X~2=0.87,P=0.35);the average hospitalization days in the observation group were 19.47±2.85 days;the average hospitalization days in the control group were 20.88±3.82 days;the average hospitalization days in the observation group were lower than those in the control group,but there was no significant difference(t=-1.74,P=0.09).The average hospitalization cost of the observation group was 8.43±0.64million,and that of the control group was 8.29±0.60 million.The average hospitalization cost of the observation group was higher than that of the control group,but there was no significant difference(t=-0.94,P=0.35).Conclusion:Digital medical 3D visualization technology applied to diagnosis and surgical treatment of hilar cholangiocarcinoma has great advantages in defining the type of tumor,evaluating the extent of invasion of the tumor,conducting individual surgical planning,simulating surgery and evaluating the resectability of the tumor,guiding the safe operation,reducing the occurrence of postoperative complications to a certain extent,and has important clinical application value.