[Application value of three-dimensional reconstruction in preoperative evaluation of precise hepatectomy for complex...

Objective: To explore the application value of three-dimensional reconstruction of liver based on computer software in preoperative evaluation of precise hepatectomy for complex primary liver cancer. Methods: The clinical data of patients in Peking University People's Hospital Hepatobiliary surgery with complicated primary liver cancer from September 17, 2019 to December 20, 2020 were analyzed retrospectively. Preoperative enhanced CT/MR data of patients were collected, and 3D reconstruction of liver was performed in IQQA􀳏-3D Liver system. The liver volume of patients was calculated, the size and location of tumor were described, and the relationship between tumor and intrahepatic bile duct, portal vein, hepatic artery and inferior vena cava was described. Preoperative decision-making and treatment plan were made to compare the compliance of the actual operation plan with the planned operation plan under the guidance of three-dimensional reconstruction. Results: Among all 10 patients, there were 6 males and 4 females, aged 36 to 75 years. There were 6 cases of Child-Pugh grade A and 4 cases of B liver function. There were 5 cases of portal vein variation and 5 cases of hepatic artery variation. The range and M(Q₁,Q₃)of actual liver volume measured by 3D reconstruction in 10 patients was 895- 2 477 cm³ and [1 444(1 001, 1 854)] cm³;the nodule volume was 7-1 808 [133(50, 566)] cm³;the nodule volume in the liver was 0.8%-73.0% [11.0(3.3,32.7)]% and the number of suspected lesions was 1-7. In the end, 6 patients received surgical treatment;3 received chemotherapy, and 1 received conservative treatment. The preoperative three-dimensional reconstruction of liver anatomy and tumor location of the patients receiving surgical treatment were basically consistent with the intraoperative situation. There was no case of liver failure or death during perioperative period. Conclusion: In the preoperative evaluation of precise hepatectomy for complex primary liver cancer, 3D reconstruction can improve the rationality of treatment and the surgeon's understanding of the anatomical characteristics of the liver, so as to select the best treatment for patients, which has great application value.