| Objective : To evaluate the application value of three-dimensional visualization technology(3DVT)in hepatocellular carcinoma(HCC)patients with cirrhosis undergoing major hepatectomy.Methods: The data of 54 patients who underwent major hepatectomy for HCC due to cirrhosis from January 2014 to June 2020 were retrospectively analyzed.Among them,27 patients(including 13 male patients and 14 female patients)were treated with 3DVT,and 27 patients(including 18 male patients and 9 female patients)were treated with traditional 2D imageological examination.All the included patients signed the informed consent and met the ethical standards,and were approved by the Ethics Committee of Taizhou People’s Hospital.In 3DVT group,DICOM files was obtained on the basis of dual-source CT enhanced examination,which was imported into the IQQA-Liver 3D statistical system workstation for reconstruction and performed virtual resection.The measured real-time data included total estimated liver volume,lesion site volume,and remnant liver volume.In the 2D group,preoperative evaluation was performed by conventional imaging examinations,such as CT or MRI,to determine the surgical plan.Intraoperative blood loss,operative time,postoperative complications,postoperative liver function recovery,and postoperative hospital stay were compared.Postoperative complications were classified by Clavien-Dindo classification(CDC),postoperative liver dysfunction referring to the INR on the 5th day after surgery was >1.7 and Ti LB>50 μmol /L,and the recovery of liver function was compared using the AST,ALT and TBIL on the third day after the operation.In addition,preoperative patients were compared with Charlson Comorbidity Index(CCI)and Cirrhosis-specific Comorbidity Scoring System(Cir Com)to evaluate the differences in preoperative comorbidities between the two groups,so as to avoid the impact of diverse comorbidities on the collected data.The relationship between the volume of preoperative proposed resection and the actual volume of intraoperative resection was compared to evaluate the accuracy of 3DVT in estimating liver volume.Results: No differences were found in Gender,age,BMI,HBs Ag(+/-),CCI and Cir Com,which proved that preoperative comorbidities had no effect in the data collected in this study.Compared with group 2D,group 3DVT was linked to shorter operation time [3.75(2.44～4.00)vs 5.30(3.50～7.50),P=0.005]and lower intraoperatve blood loss [500(425～625)vs 650(600～750),P=0.02].And a significant difference in risk of postoperative complications was found across the 2 cohorts(P=0.04).Then,the groups were similar in postoperative hospital stay:(13.26±4.27 vs 14.41±0.59,P=0.37),and liver function recovery including ALT,AST and TBIL [166(100～292),69(50～139),29.6(17.4～48)vs 179(92～352),120(43～221),24.9(18.5～30.8),P=0.95,P=0.22,P=0.18)].Portal vein variation in 3DVT group: 13 cases of type A(48.15%),10 cases of type B(37.04%),2 cases of type C(7.41%),and 2 cases of type D(7.41%).And hepatic artery variation: 16 cases of type 1(59.26%),5 cases of type 2(18.52%),4cases of type 4(14.81%),1 case of type 5(3.70%),and 1 case of type 7(3.70%).In3 DVT group,preoperative virtual excision volume-actual excision volume= 40.20±101.88(ml),and there’s no difference(P=0.51).Conclusion: 3DVT established 3D visual images and performed virtual resection,while the liver volume was estimated.This study showed that there was no difference between the volume of virtual resection and the actual volume of liver resection,which proved that 3DVT could accurately estimate liver volume.In addition,this study proves that 3DVT can guide surgeons to reduce unnecessary bleeding during surgery and reduce operation time.Although there is no difference in the influence of postoperative liver function recovery and postoperative hospital stay,the risk of postoperative complications is lower,which improves the situation of postoperative complications in patients. |
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