ABSTRACT
Objective To investigate the accuracy of liver volume measurement in patients with primary hepatocellular carcinoma by using the 3D + medical imaging visualization processing system. Methods Thirty patients who were clinically diagnosed as primary hepatocellular carcinoma and underwent surgical resection before preoperative assessment were selected from January 2016 to November 2016. Preoperative thin-slice CT images were transferred into the 3D + medical imaging visualization processing system for hepatic volume measurement, the predictive resection volume were measured and statistically analyzed with that of intraoperative specimen according to water measurement method. Results All patients had complete resection of tumor, the average volume of predictive resection calculated by the 3D software was (408.84 ± 177.07) ml, the average volume of intraoperative specimen measured by the water test was (399.95 ± 176.15) ml, the difference was not statistically significant (t=1.502, P=0.144), and the average percentage error was (6.21 ± 4.73) %. Pearson correlation analysis showed that there was significant correlation between them (r=0.983, P<0.05). Conclusion 3D+medical image visualization processing system is a simple, intuitive and accurate method for liver volume measurement, which can provide the basis for the accurate measurement of liver volume and the implementation of complex hepatectomy, and guide the precise hepatectomy.
ABSTRACT
Objective To explore the use of the right hepatic pedicle to guide classification of liver neoplasms on medical imaging and the type of liver resection.Methods From January 2009 to December 2012,32 patients with a single liver neoplasm surrounding the right hepatic pedicle,including 17 patients with primary liver cancer and 15 patients with cavernous hemangioma of liver,were recruited into this study in our hospital.Using the position of the neoplasm in relation to the right hepatic pedicle on CT or MRI,these liver neoplasms were divided into 4 types:type A neoplasms which infiltrated or surrounded the right hepatic pedicle; type B neoplasms which were in the front of the right hepatic pedicle; type C neoplasms which were at the back of the right hepatic pedicle,and type D neoplasms which were between the two branches of the right hepatic pedicle.Before surgery,a simulated plan was designed on the different hepatic vascular inflow obstruction and types of hepatectomy based on the classification in medical imaging.Results The locations of the liver neoplasm were completely in line with the preoperative imaging classification.Boththe vascular flow obstruction and the types of hepatectomy correlated with the preoperative surgery simulation planning.Five patients with type A neoplasms underwent right hemihepatectomy or extended right hepatectomy; 8 with type B tumors underwent right anterior sectionectomy or mesohepatectomy; 9 with type C neoplasms underwent segment Ⅴ,Ⅵ resection; 10 with type D tumors underwent right anterior or right posterior sectionectomy.Pringle maneuver,total hepatic blood inflow obstruction and selective right hepatic blood inflow obstruction were applied according to the operation and the regional anatomical structures.All operations were smoothly carried out with an average operation time of 145 min.The average blood loss was 320 ml and 18 patients required intraoperative blood transfusion with an average blood transfusion amount of 460 ml.Postoperative complications included bile leakage (n =3),right pleural effusion (n =2) and hemorrhage (n =1).They all responded to conservative treatment.Conclusion This classification using preoperative medical imaging of the right hepatic pedical could provide important information for liver resection,and it is helpful for formulating more refined operation scheme.
ABSTRACT
Objective To evaluate the the safety and efficiency of precise liver resection for patients with primary liver cancer. Methods 86 patients with primary liver cancer were randomized to receive conventional routine hepatectomy (n=44) or the precise liver resection (n=42). Outcomes were compared between the precise hepatectomy group and the routine group, including, the blood loss, operation time, morbidity and mortality. Results There were significant differences in morbidity rates (7.1% vs. 20.5%; P<0.001), the blood loss [(320±315) ml vs. (613±526) ml;P<0.001) , postoperative alanine aminotransferase (ALT) value (in postoperation 7 d, 82.7 U/L vs.321.7 U/L; P<0.001) and length of hospital stay (12.3 d vs. 18.6 d; P<0.001) between precise hepatectomy and routine groups. The 1 year tumor recurrence rate and 1 year survival rate were 26.2%(11/42) and 78.6% (33/42) in precise liver resection group, 38.6% (17/44) and 65.9%(29/44) in routine liver resection group,with significant difference (P=0.010;P=0.018). Conclusion Precise liver resection is safe and effective in the treatment of liver tumor without much injury to patients.