The Value Of Three-dimensional Visualization Technology In The Perioperative Period Of Perihilar Cholangiocarcinoma

Objective:Perihilar cholangiocarcinoma,as a common biliary tumor,has a low surgical resection rate and poor prognosis due to its special location and the fact that patients are mostly in the middle and late stages when they present to the clinic.Currently radical resection is still the most effective method to treat perihilar cholangiocarcinoma,prolong patients’ survival and improve prognosis.Along with the development of digital technology,three-dimensional visualization technology has been extensive used in various fields,such as hepatobiliary surgery.The purpose of this paper is to further study the effect analysis of three-dimensional visualization technology on the application of radical resection for different Bismuth staging of perihilar cholangiocarcinoma,to provide a basis for the application value of three-dimensional visualization technology in the perioperative period of perihilar cholangiocarcinoma,and to provide options for individualized treatment of this disease.Methods:In this research,we retrospectively analyzed the clinical data of patients with perihilar cholangiocarcinoma who were treated in the Hepatobiliary and Pancreatic Surgery and Liver Transplantation Center of the First Affiliated Hospital of Shanxi Medical University and Shanxi Cancer Hospital from November 2019 to November 2022.A total of 65 cases were screened.Based on the preoperative CT data,the patients were divided into four groups according to the Bismuth-Corlett staging method,including type I and type II,type III and type IV,and whether preoperative three-dimensional visualization technology was performed or not.The preoperative baseline data,intraoperative and postoperative related data were collected in detail,and the data differences between groups were analyzed to determine whether the application effect of three-dimensional visualization technology in radical resection of perihilar cholangiocarcinoma with different Bismuth classification was effective.Results:Based on the collected clinical data,we found that there was no significant difference in general data such as age,gender,ALB,history of abdominal surgery,history of preoperative yellow reduction,time to yellow reduction,Child-Pugh score,prothrombin time,history of hepatitis B,AFP,CA19-9,CEA,CA50,CA72-4,TBIL,ALT and AST among the groups(all P>0.05).There is 11 cases(78.57%)in the control B group whose the actual extent of intraoperative resection > the expected extent of resection and 7 cases(35.00%)in the 3D B group(P=0.014),and the operative time was(639.36 ± 97.91)min vs.(511.55 ± 152.45)min(P=0.018),with 6 cases(42.86%)in the control B group in which the first incision margin was R0 was achieved,compared to 16cases(80.00%)in the 3D B group(P=0.028),intraoperative bleeding was(367.86±495.21)ml vs(190.91±144.60)ml(P=0.045),intraoperative transfusion rate was 12 cases(85.71%)vs 7 cases(35.00%)(P=0.004),and postoperative hospital stay(22.93±5.66)days vs(15.20±3.98)days(P=0.000),the differences were statistically significant(P<0.05).The intraoperative bleeding volume in control A group(257.14±123.92)ml was worse to that in 3D A group(159.09±53.94)ml,and the difference was statistically significant(P=0.033,P<0.05).There were no significant differences in operation time,the number of patients whose the actual extent of intraoperative resection > the expected extent of resection,intraoperative transfusion rate,the time of going to the field after operation and postoperative hospital stay(P > 0.05).The postoperative complications were mainly hydrothorax and ascites,among which there was one case of postoperative gastrointestinal bleeding and one case of postoperative bile leak in control B group,one case of postoperative bile leak and one case of postoperative gastroparesis in 3D B group,and one case of postoperative abdominal bleeding in control A group.All of them improved after symptomatic treatment,and the differences in incidence between the groups were not statistically significant(P>0.05).And it was found that the differences were not statistically significant(P>0.05)after observing the postoperative ALT,AST,ALB and TBIL(measured on postoperative days 1,3 and 5),except that the ALB on day 5 in 3D B group was better than that in control B group(32.89 ± 2.21)g/L vs(36.49 ± 2.22)g/L(P=0.011).Conclusion:Preoperative three-dimensional visualization technology can help the operator to visualize the tumor site,clarify the surrounding vascular adjoining relationship,the scope of involvement and variation,plan the scope of surgical resection,and accurately assess the volume of the participating liver,thus improving the surgical efficacy,reducing intraoperative bleeding,avoiding serious surgical complications,and reducing the patient’s postoperative hospital stay.In this study,the preoperative three-dimensional visualization technology was of guiding significance for the radical treatment of perihilar cholangiocarcinoma with Bismuth staging type III and type IV,but the significance for the radical treatment of perihilar cholangiocarcinoma with staging type I and type II,remains to be discussed and validated.