The Application Analysis Of MI3DVS In Laparoscopic Anatomic Hepatectomy And Non-anatomic Hepatectomy

Objectives:1.Discuss the application value of MI3DVS in preoperative planning of HCC2.Compared the postoperative efficacy of laparoscopic anatomic hepatectomy and non-anatomic hepatectomy for HCC;Methods:Retrospective analysis was conducted to collect clinical data of 90 patients with hepatectomy in the second affiliated hospital of kunming medical university from July 2015 to July 2017.256 rows spiral CT should be used in all preoperative patients on abdomen scan and the third phase of enhanced CT scan for thin layer data,using MI3DVS for three-dimensional reconstruction,according to tumor spatial location,tumor and intrahepatic duct system of spatial relations,virtual resection of plane design,simulation of tumor,calculate the liver volume,resection of liver volume and residual liver volume,and calculate the residual liver volume percentage.According to preoperative liver function classification and residual liver volume percentage,the final hepatectomy was determined.According to the proposed method of hepatectomy,it is divided into dissection and non-dissection.Two groups of preoperative,intraoperative and postoperative data were collected and compared.Results:1.Preoperative:(1)Preoperative all patients underwent a liver three-dimensional reconstruction can clearly show the intrahepatic Glisson system and hepatic vein of three-dimensional anatomical morphology,liver individualized segmentation and spatial location of the tumor and the liver three-dimensional images for stereo sense is strong,can clearly identify the tumor and the spatial relationship of liver pipeline system.It can accurately predict the extent of liver resection through the virtual liver resection plane,and can calculate the liver volume and residual liver volume of the virtual resection,and have some guidance for the development of the surgical plan.(2)According to the preoperative assessment of three-dimensional reconstruction technology of liver resection operation is divided into laparoscopic anatomic group and non anatomic group,including preoperative of laparoscopic anatomical group with 40 cases,laparoscopic non anatomic group with 50 cases.(3)40 cases of laparoscopic anatomic group according to the preoperative plan successfully completed the scheduled surgery in patients with laparoscopic anatomical liver resection,50 cases of laparoscopic non anatomic group according to the scheduled surgery preoperative plan successfully completed the laparoscopic non-dissection liver resection,the two groups of actual operation were consistent with the preoperative procedure.(4)Preoperative two groups of cases of gender,age,number of cases of cirrhosis,liver function index,liver function Child classification,AFP,tumor size and location had no statistical significance(P>0.05),comparable.2.Intraoperative:the amount of bleeding in the dissection group under laparoscopic surgery was less than that of the non-anatomical group under laparoscopy,and the comparison was statistically significant(P<0.05).The operation time of the non-anatomical group under laparoscopy was less than that of the laparoscopic anatomical group,and the comparison was statistically significant(P<0.05).3.Postoperative:(1)There was no statistically significant difference in postoperative hospitalization days and postoperative complications between the laparoscopic dissection group and the laparoscopic non-anatomical group(P>0.05).(2)The satisfaction rate of the cutting edge of the dissection group was significantly better than that of the non-anatomical group,which was statistically significant(P<0.05).(3)There was no statistically significant difference between the preoperative virtual resection of the liver and the actual resection of the liver.(P>0.05),but both have positive correlation(P<0.05).(4)Laparoscopic anatomical postoperative AST,ALT and TBIL in 1 and 3 day after surgery were lower than that in group of non-anatomy,comparing with statistical significance(P<0.05);There was no significant difference between the two groups of AST,ALT and TBIL on the 7th day after surgery(P>0.05).There was no significant difference between the first day,the third day and the seventh day after laparoscopic dissection and laparoscopic non-dissection(P>0.05).(5)The overall survival rate of the dissection group was significantly higher than that of the non-anatomical group in 1 year,which was statistically significant(P<0.05),but there was no significant difference between the overall survival rate in 6 months and the total survival rate in 2 years(P>0.05).(6)The no tumor survival rate of the dissection group was significantly higher than that of the non-anatomical group in 1 year and 2 years,which was statistically significant(P<0.05).However,there was no significant difference between the two groups within 6 months after surgery(P>0.05).Conclusions:1.Three-dimensional reconstruction technology can be observed the space relation of liver cancer and liver pipeline system clearly,clear the liver variation degree of pipeline system,and accurately predict the resection of liver tumors,guided surgery procedures,improve the resection rate,therefore,it has certain application value in the preoperative planning of HCC hepatectomy.2.Compared with non-anatomical hepatectomy,laparoscopic anatomic hepatectomy can reduce intraoperative blood loss,reduce postoperative liver function damage,and improve postoperative incisal margin satisfaction,but the operation time is long.3.Compared with non anatomical liver resection,anatomic hepatectomy can improve postoperative 2 year no tumor survival rate and postoperative 1 year overall survival rates,but 2 years after surgery there was no difference in the two kinds of operation on the overall survival rate.