Application Of Three-dimensional Visualization Technology In Precise Hepatectomy

Objective1.To study the role of 3D visualization technology in discovering anatomical variation of intrahepatic duct,defining the stereoscopic relationship between the tumor and the surrounding intrahepatic duct,assisting in preoperative evaluation,and developing a precise hepatectomy protocol,also explain the changes that 3D visualizations bring to traditional 2D imaging in the development of treatment protocols.2.To study the role of 3D visualization technology in improving the rate of surgical resection,and reducing the incidence of postoperative complications.MethodsThe clinical data of 40 patients with hepatobiliary tumor who prepared to have an hepatectomy in the Hepatobiliary and Pancreatic Surgery of Shanghai Sixth People’s Hospital from January 1,2017 to March 1,2019 was retrospectively analyzed in this study.Abdominal CTA examination was conducted in each patients enrolled.Then use 3D visualization technology to reconstruct 2D image into 3D liver model.Before surgery,the anatomical variation of hepatic artery,portal vein,hepatic vein and the stereoscopic relationship between the tumor and the adjacent intrahepatic duct were observed in 3D liver model.Then,determining the virtual hepatic resection plane,measured and recorded liver volume virtually resected,residual liver volume,standard liver volume,and ratio of residual liver volume to standard liver volume,which facilitate to assess tumor resectability,surgical risk of hepatectomy,and develop an appropriate treatment plan.In the while,Developing treatment plans based on 2D images and 3D visualization models,and observe the changes that 3D visualization technology brings to traditional 2D images in developing treatment plans.Then,the operation was performed according to the three-dimensional visualization surgical plan and the operation time,intraoperative blood loss,intraoperative hepatic occlusion time and postoperative complications were observed.Results1.Among the 40 patients,24 cases of hepatic artery Michels classification type I,2 case of type II,3 case of type III,4 case of type V,2 case of type VI,3 case of type VII.Type IV,type VIII,type IX,type X were not found.2 case was found not within the Michels classification.Among the portal vein variability classification,33 cases of type I(common type),4 cases of type II,2 cases of type III,and 1 case of type IV,no special variation was found.In the hepatic vein variability classification,according to the way the left,middle and right hepatic vein were transferred into the inferior vena cava,31 cases were type I and 9 cases were type II.According to the Nakamura classification,31 cases were type I,7 cases were type II,2 cases were type III,and no special variation type was found.2.According to the relationship between the tumor and the surrounding intrahepatic duct,there were 5 cases of tumor compression or invasion of the hepatic artery and its main branches,12 cases of tumor compression or invasion of the portal vein and its main branches,10 cases of tumor compression or invasion of the hepatic vein trunk,6 cases of tumor compression or invasion of the inferior vena cava.3.12 of the 40 patients changed the two-dimensional treatment plan,and 6 of them reduced the scope of surgery and 1 cases were enlarged.6 patients changed their treatment plan due to insufficient liver volume,5 patients underwent transcatheter arterial chemoembolization,and 1 patient underwent associating liver partition and portal vein ligation for staged hepatectomy.4.Of the 40 patients,35 underwent direct surgery,including 6 patients with right hepatectomy,2 patients with right tricuspid resection,8 patients with left hepatectomy,3 patients with medial hepatectomy,and 12 patients with hepatic segmentectomy and combined segmental resection(1 case of segment VI resection,1 case of segment VIII resection,2 cases of segment IVb resection,2 cases of segment IV and V segment resection,2 cases of segment V and VI segment resection,and 1 case of segment VII and VIII resection,1 case of resection of segment V,VII and VIII,2 cases of resection of segment V and VI + partial segment IV),4 cases of irregular hepatectomy.There were no liver failure or death after operation,3 cases of errhysis from liver wound,10 cases of pleural effusion,8 cases of peritoneal effusion,1 case of biliary fistula,2 cases of pulmonary infection,and 2 cases of deep vein thrombosis of lower extremity.Conclusion3D visualization technology can detect the anatomical variation of intrahepatic duct,and observe stereoscopic relationship between the tumor and the surrounding intrahepatic duct,so as to carry out accurate preoperative evaluation and develop a surgical plan,which can improve the surgical resection rate and reduce the occurrence of postoperative complications.