| Objective:To explore the application and clinical significance of three-dimensional reconstruction in hepatectomy.Methods:From March 2018 to February 2020,three-dimensional reconstruction of liver was carried out in the First Affiliated Hospital of Nanchang University.The patients' portal vein classification and hepatic artery classification were judged,and the interaction between hepatic artery variation and portal vein variation was evaluated.The preoperative tumor volume,residual liver volume and the actual tumor volume,residual liver volume ratio after operation were evaluated The patients were divided into two groups: group A(variant group)and group B(non variant group).Retrospective analysis of the two groups before the operation of the simulated operation and the actual operation,the amount of bleeding,operation time,postoperative complications,postoperative hospital stay and so on.Result:1.In this study,69 patients who completed three-dimensional reconstruction of liver were collected.There are four types of portal vein: type A(typical branch form of portal vein)59 cases(85.51%),type B(trigeminal)3 cases(4.35%),type D(I-shaped)6 cases(8.69%),type E(other rare variant form)1 case(1.45%);the total variation rate of peripherally hepatic portal vein is 14.49%;there are 11 types of hepatic artery in total,which is consistent with Michels There are 7 types of classification: 46 cases of type I(66.67%),3 cases of type III(4.35%),1 case of type VI(1.45%),6 cases of type V(8.69%),3 cases of type VI(4.35%),1 case of type VII(1.45%),4 cases of type IX(5.79%),a total of 64 cases;and 5 cases of four types do not belong to Michels Among them,1 case(1.45%)was from the left hepatic artery,2 cases(2.89%)from the right hepatic artery,1 case(1.45%)from the gastroduodenal artery,1 case(1.45%)from the gastroduodenal artery,and the overall variation rate of the hepatic artery was 33.33%(the standard was type I).2.The variation rate of hepatic artery was 35.59% in 59 patients without variation of portal vein and 20.00% in 10 patients with variation of portal vein.There was no significant correlation between variation of portal vein and variation of hepatic artery(P = 0.55).3.In group A,14 cases underwent left hemihepatectomy,13 cases underwent left hemihepatectomy,1 case underwent left lateral lobectomy;17 cases underwent right hemihepatectomy,17 cases underwent right hemihepatectomy,the accuracy of operation was 96.77%;in group B,16 cases underwent left hemihepatectomy,16 cases underwent left hemihepatectomy;right hemihepatectomy was performed before operation 22 cases were operated,20 cases were operated on right hepatectomy,2 cases were operated on abdominal switch because of left hepatectomy,the accuracy rate was 94.74%,the overall accuracy rate was 95.65%.4.In 69 patients,the left half liver volume percentage was 18.99% ~ 58.23%,the right half liver volume percentage was 41.74% ~ 81.01%;the postoperative residual liver volume fraction was 42.37% ~ 78.96%,the preoperative tumor volume and the postoperative actual tumor volume [(258.08 ± 180.82)ml vs.(264.72 ± 187.38)ml,P = 0.89],the preoperative residual liver volume and the postoperative residual liver volume [(692.81 ± 242.26)ml vs.(736.34 ± 216.75)ml,P = 0,.26].5.The operative time of group A was(195.29 ± 41.51)min vs.(214.72 ± 30.69)min,P = 0.02),which was significantly lower than that of group B(P < 0.05);the amount of intraoperative bleeding was(547.37 ± 420.14)min vs.(526.83 ± 307.16)ml,P = 0.81),the postoperative hospital stay was(8.76 ± 2.82)d vs.(9.22 ± 1.96)d,P = 0.42],there was no significant reduction in group a compared with group B;postoperative complications [3 cases(9.67%)vs.5 cases(13.16%),P = 0.94],there was no significant reduction in group a compared with group B.Conclusion:Three dimensional reconstruction technology can clearly and intuitively display the variation of portal vein and hepatic artery,which is of great significance to the perioperative period of hepatectomy patients.. |
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