Application Of Three-dimensional Reconstruction Technology In Precise Hepatectomy For Complex Hepatocellular Carcinoma

Objective:To explore the clinical application value of three-dimensional r econstruction technology in the precise resection of complex hepatecular c arcinoma(CHCC).Methods:A prospective analysis analysis was performed on 49 patients w ith CHCC who underwent treatment in Guangxi Medical University Cance r Hospital from June 2017 to February 2019.Two-dimensional(2D)and th ree-dimensional(3D)techniques were applied to preoperative assessment an d the formulation of surgical procedures of 49 patients with CHCC,respe ctively.Firstly,2D technology was used by the treatment team to assess t he patient’s condition and to preliminarily formulate the treatment plan.Se condly,the team reassessed the patients based on 3D technology and deve loped treatment plans again.The operative time,intraoperative bleeding vo lume and postoperative complication rate of the patients were recorded by the them.The virtual excision liver volume(vELV)was compared with t he actual excision liver volume(aELV),and the simulated margin was co mpared with actual resected margin.Results:The 2D schemes of 12 patients(24.5%)were adjusted after 3D evaluation.Among these patients,the therapeutic plan for 1 patient was ch anged from surgery to transcatheter arterial chemoembolization(TACE),t he surgical plans for 1 patient was changed from TACE to surgery,and t he plans for the remaining 10 patients were changed from one surgical m ethod to another.The median operative time was 240(145-350)minutes.The median number of hepatic hilar occlusions was 1(0-6),and the medi an time of hepatic hilar occlusion was 20.5(0-83)minutes.The intraoper ative bleeding volume was 275(60-5000)ml.In addition,There was a st atistically significant correlation between vELV and aELV(r=0.982,p<0.001).There was no significant difference between the two mean values(952.7±514.9 ml vs 895.3±540.5 ml).There was also a significant correlati on between the simulated surgical margin and the actual surgical margin(r=0.908,p<0.001),and there was no significant difference in the mean value between the two groups(11.9±2.9 mm vs 9.5±2.4 mm)(Fig.2).N o postoperative Clavien Ⅲ-Ⅴ complications occurred in all patients and whom recovered smoothly and discharged from hospital at 10.5(5～37)d ays after the operation.Postoperative pathology showed that all patients a chieved R0 resection.Conclusions:Three-dimensional reconstruction technology can accurately evaluate the liver condition and optimize the operation scheme,which pla ys an important role in the accurate hepatectomy of CHCC.