Application Of 3D Reconstruction Combined With B-ultrasonic Navigation In Precise Hepatectomy

Objective To evaluate the application value of three-dimensional reconstruction combined with B-ultrasonic navigation in precise hepatectomy.Methods 64 row spiral CT was used to examine the data of upper abdomen or whole abdomen plain scan plus enhanced CT.The data of plain scan,arterial phase,portal phase and venous phase were recorded on CD and then imported into the three-dimensional reconstruction system(incool)digital medical image diagnosis software in DICOM format Three dimensional reconstruction was performed on thin slice(<2mm)CT image data of patients with liver tumor.Reconstruct 3D models of liver and liver tumors,and reconstruct models of hepatic arteries,hepatic veins,and portal veins.Find and segment lesions,view 3D reconstructed images from multiple angles,determine the relationship between tumors and surrounding blood vessels,complete virtual surgery designs,develop personalized surgery plans,and provide guidance for clinical surgery.Using a three-dimensional reconstruction system,total liver volume,lesion volume,liver volume before resection,residual liver volume,and other data were measured.The 3D reconstruction system measured each group and measured the sample size of the data by actual drainage during surgery for comparative analysis.During the operation,B-ultrasonic navigation technology was used to detect the number and distribution of liver lesions and the anatomical relationship with important hepatic vessels,focusing on detecting the small lesions which not be finded before the operation and modifying the operation plan,finally determining the level of liver parenchyma disconnection,and guiding the completion of the operation by fusion of three-dimensional reconstruction image.Results The 3D reconstruction model of all 30 cases was perfect,the tumor of 18 cases were located in the right half of the liver,12 cases in the left half of the liver.Among the 30 cases,3 cases after the preoperative 3D reconstruction evaluation denied the surgical plan based on traditional imaging and other treatment methods.Therefore,27 patients developed a precise hepatectomy surgical plan based on the results of three-dimensional reconstruction,and performed virtual surgical resection before surgery.Among them,10 cases were pre-operatively 3D printed.According to the 3D printing model,further detailed planning of the operation was carried out.Three dimensional reconstruction showed that the variation rate of hepatic artery,portal vein,right posterior inferior hepatic vein was 30.0%,36.7%,37.0%and 7.7% respectively.The volume of the resected liver measured by three-dimensional reconstruction method is significantly related to the volume of the specimen obtained by drainage method in the actual operation.The median pre-resected liver volume was 722.74 ml,and the actual volume of liver resected was 784.89 ml.Z =-1.689,P = 0.091,the difference was not statistically significant.The actual surgical method of all patients is basically the same as the preoperative resection method.Most of the tumors,vessels and the relationship between them were the same as the three-dimensional reconstruction before operation.Two patients(7.69%)changed the surgical plan after intraoperative B-mode navigation during operation.One patient was denied surgical plan based on traditional imaging and three-dimensional reconstruction after intraoperative B-mode ultrasound evaluation.Conclusion Three dimensional reconstruction and intraoperative B-ultrasonic navigation technology have certain application value in the preoperative evaluation of liver tumor,and are conducive to the optimization of the choice of precise hepatectomy.