Clinical Research Of The Guidance Of The3D Reconstruction And Mimetic Hepatectomy Model With Intelligent CT For The Anatomic Hepatectomy

[Objective] Consummating the3D reconstructionand establishing a mimetic model of anatomical hepatectomyby intelligent CT at preoperation, in order to research the guidance of3D reconstruction and mimetic hepatectomy model with intelligent CT for anatomic hepatecmomy.[Methods]96patients, who were treated with the anatomic hepatecmomy are divided into observation group(n=47) and control group(n=49)in our team between Dec.2012to Feb.2014. At the observation group, we consummate the3D reconstruction model for the HV, HA and biliary tract, and reconstruct the volume of liver, and then, we establish a mimetic model of anatomical hepatectomy by intelligent CT before the operation. Then we treat the patient whit the anatomic hepatecmomy by the guiding of the3D model. At the control group, we consummate a CT routinely without3D reconstruction before the operation, and then treat them by the same operating method. fter all, we research for the reliability of the reconstruction model and compare the quality between the mimetic model of removed liver and the real removed liver. Meanwhile we compare the clinical data between the two team, including the operation time, intraoperative blood loss, hospital stay, postoperative liver function recovery, complications and malignant tumor cure rate(edge negative rate) and the tumor recurrence etc., in order to evaluate the guidance of the mimetic hepatectomy model with intelligent CT for the anatomic hepatectomy.[Results](1)The3D liver reconstruction model can indicate the anatomical distribution of intrahepatic vascular really. And it can improve the efficiency of blood blocking of the target segment in anatomic hepatectomy. Theresults accord with Takasaki K’s theory, and also suggests that about11%of the patients is not fit to choose Glisson sheath cross-sectional liver resection.(2)There is no statistical difference in quality between the mimetic removed liver model and the actual removed liver.(3)The observation group in the intraoperative blood loss, liver function recovery section index is better than that of control group, and there were no significant differences in hospitalization time and operation time.(4)Theliver failure and the incidence of postoperative bile leakage in the control group were higher than in observation group, but there is no obvious difference between theincidence of pulmonary infection, abdominal cavity infection and pulmonary embolism.(5)The cancer radical resection rate in the observation group is higher than the control group, and the tumor recurrence rate is lower than the control group in the near future.[Conclusion](1) The3D liver reconstruction model can indicate the anatomical distribution of intrahepatic vascular really, and the high simulation model of liver resection can indicatethevolume and quality of the practical clinical liver resection, can effectively improve the precision of clinical anatomical hepatectomy;(2) It can provide the basis for clinical surgery design, and it is helpful in the preoperative prediction and the guidance of anatomical hepatectomy, and the3D liver reconstruction model can improve the effect of blocking, reduce intraoperative blood loss, is good for the protection of residual liver and it can reduce the occurrence of the complications; (3) The3D liver reconstruction modelcan reduce the incidence of malignant tumor cut edge positive and recent recurrence rate to improve the survival,.whether intelligent CT3D reconstruction of liver resection model can make the receiving anatomical liver resection of liver cancer patients with long-term benefit remains to be further research.