The Study Of Three-dimensional Reconstruction Application In Measurement Of Hepatic Segments Volume And The Correlation Between Residual Liver Volume And Hepatic Funtion After Hepatic Resection

PARTⅠThe study of three-dimensional reconstruction application in measurement of hepatic segments volumeObjectiveTo reconstruct the three-dimensional images of liver, hepatic segments by virtual liver surgery planning software Liv1.0, and measure volumes to provide reference for liver surgery.MethodsBased on the two-dimensional image data collected by the 16-slice helical CT scanning, three-dimensional visualized models of 82 cases of normal liver and hepatic segments were reconstructed, the image information of liver and interior vessel was showed thoroughly and hepatic segments volumes were measured automatically with the virtual liver surgery planning software Liv1.0.ResultsThe mode had high fidelity and its anatomical landmarks was clear .The branches of intrahepatic portal veins, hepatic venous system and their relationship can be displayed distinctly. The boundaries between the hepatic segments are not straight. The mean total liver volume was(1236±221)ml and hepatic segments volumes were: segmentⅠandⅨ(21±7)ml, segentⅡ(151±49)ml, segmentIII (131±37)ml, segmentⅣ(165±46)ml, segmentⅤ(201±52)ml, segmentⅥ(146±45)ml, segentⅦ(177±55)ml, segmentⅧ(252±78)ml.The percentages of segment (Ⅰ,Ⅸ)toⅧwere(1.8±0.3)%,(12.1±2.5)%,(11.3±2.3)%,(15.0±3.2)%,(18.3±4.3)%,(12.5±3.3)%,(14.5±2.0)%,(22.2±4.6)% respectively. The left liver (segments II,III and IV) volume was(449±92)ml and the right liver(segments V,VI,VII,and VIII) was(788±149)ml.ConclusionThe three-dimensional images of liver and hepatic segments can be well reconstructed and the volume was measured accurately by the virtual liver surgery planning software Liv1.0.This can provide reference for the living donor liver transplantation and segment-oriented liver surgery.PARTⅡA study on the correlation between residual liver volume and hepatic funtion after hepatic resectionObjectThe residual liver volume (RLV) and standardized estimated liver remant ratio(STELR)after hepatic resection for the patients with primary hepatocellular carcinoma was calculated by the software Liv1.0.The relationship between STELR and hepatic funtion index was explored for accurately assessment of hepatic function and avoidance of hepatic dysfunction.MethodsThe study population consisted of 40 patients with PHC undergoing hepatic resection, and RVL after hepatoma resection was estimated by virtual liver surgery planning software Liv1.0.The standardized estimated liver remnant ratio (STELR) was determined as the ratio of the residual liver volume to the standardized total liver volume (STLV). Peak bilirubin level,peak prothrombin time lever, peak alanine aminotransferse lever, minimum albumin level, minimum cholinesterase level of postoperative within 30 days for all patients were measured. The correlation between RLV and hepatic funtion index was analysised.ResultsVolumetric analysis of the residual liver volume after resection correlated with the peak prothrombin time (r=-0.6951,P<0.001), peak bilirubin level (r=-0.7980, P<0.001), minimum cholinesterase level (r=0.7883,P<0.001).It had no correlation with minimum albumin level and peak alanine aminotransferse lever.ConclusionThe residual liver volume had significant correlation with the peak level of the total bilirubin , minimum value cholinesterase and peak level of prothrombin time in 30 days after operation. It provided evident for arranging detailed surgical plan and estimating the residual liver volume to avoid the risk of liver surgery.