Application Of 3D Visualization Technique In Laparoscopic Left Hemihepatectomy For Hepatoma

Objective:To investigate the efficacy of three-dimensional visualization technology in laparoscopic left hemihepatectomy for hepatocellular carcinoma,and to analyze and evaluate the safety and feasibility of three-dimensional visualization technology in the perioperative guidance of laparoscopic left hemihepatectomy for hepatocellular carcinomaMethods:A retrospective analysis was performed on 61 patients with left hepatic lobe occupying lesions admitted to the general surgery ward of Yulin Red Cross Society from March 2019 to March 2021.Patients with primary hepatocellular carcinoma diagnosed by laparoscopic resection of occupying lesions were divided into the control group(30 cases)and the study group(31 cases)according to whether three-dimensional reconstruction of liver was performed.Study group(group A): Three-dimensional visualization technology was used to establish a three-dimensional liver model before operation to evaluate the adjacent condition of the tumor and the surrounding blood vessels,and to determine the left hemihepatectomy plane.Intraoperative ultrasound assisted real-time positioning was used to determine the course of the blood vessels and the liver resection plane.In the control group(group B),the tumor location was determined by preoperative upper and lower abdominal plain scan +enhanced CT or liver specific MRI(Prometasine),and the location was assisted by intraoperative ultrasound,and left hemihepatectomy was planned.Comparative analysis: 1)Preoperative data: age,gender,liver function classification,indocyanine green clearance test,preoperative albumin,transaminase levels(ALT,AST),preoperative alpha-fetoprotein(AFP),abnormal prothrombin PIVKA-II;2)intraoperative indicators(intraoperative blood loss and blood transfusion ratio,operation duration);3)Postoperative recovery indicators(including gastrointestinal recovery time,liver function recovery indicators,abdominal drainage removal time),postoperative complications(including ascites,hypoproteinemia,bile leakage,liver failure)and length of hospital stay were compared between the study group and the simulated resected liver volume.4)Postoperative follow-up: tumor recurrence-free survival rates within1 and 3 years after operation in the two groups.The data obtained in this study were statistically analyzed by SPSS26.0,and P<0.05 was considered statistically significant..Results:There was no significant difference in preoperative general data between the two groups(P>0.05).Intraoperative data: blood loss in group A vs.group B [356.6±118.7 ml vs.494.7± 131.1 ml,P= 0.001],intraoperative blood transfusion between the two groups(χ~2=3.91,P=0.047),P <0.05,the difference between the two groups was statistically significant,the blood loss and blood transfusion rate in group A were less than those in group B;Postoperative data of group A and group B: Day 1 ALT[95.0±117.6 U/L vs 159.6±226.1 U/L,P=0.017],day 3 ALT[77.3±70.1 U/L vs 132.5±114.6 U/L,P=0.017];P=0.026],Alt on day 7[31.26±13.7 U/L vs 43.09±18.08 U/L,P=0.006],AST on day 1 [103.7±40.6 U/L vs216.1±48.6 U/L,P=0.026],P=0.029],AST on day 3 [54.45±42.6 U/L vs 83.8±50.8U/L,P=0.017],AST on day 7 [28.57±18.3 U/L vs 39.31±32.23 U/L,P=0.017],and AST on day 3 [28.57±18.3 U/L vs 39.31±32.23 U/L,P= 0.029].The liver function of group A was better than that of group B(P<0.05).The length of hospital stay of group A was shorter than that of group B [12.3 ±1.4d vs 13.9±1.20 d,P=0.047],the difference was statistically significant.There was no significant difference between the actual liver resection volume and the simulated liver resection volume in the study group(387 ±58 ml vs 379±68 ml,P=0.63),but the incidence of postoperative complications in group A was lower than that in group B.The 1-year and 3-year disease-free survival rates were 73.3%(22/30)vs 74.2%(23/31)and53.3%(16/30)vs 51.6%(16/31),respectively.Log Rank(Mantel-Cox)correlation analysis of the two groups in the first year and the third year after surgery P=0.838,P>0.05,the difference was not statistically significant.Conclusion:The actual resected liver volume of laparoscopic left hemihepatectomy is similar to that of 3D simulated hepatectomy.The application of 3D visualization technology in the perioperative period of laparoscopic left hemihepatectomy can provide a safer and more accurate plan,reduce intraoperative blood loss,operation time,intraoperative liver injury,and accelerate postoperative recovery of patients,and there is no increase in tumor recurrence rate in the 3D group during postoperative follow-up.