Significance of three-dimensional reconstruction as a method of preoperative planning of laparoscopic radiofrequency ablation
10.3760/cma.j.issn.0529-5815.2016.09.009
- VernacularTitle:三维重建术前规划在腹腔镜超声引导的肝癌射频消融术中的应用探讨
- Author:
Wenwen ZHANG
1
;
Hongguang WANG
;
Xianjie SHI
;
Mingyi CHEN
;
Shichun LU
Author Information
1. 解放军总医院肝胆外科
- Keywords:
Liver neoplasms;
Catheter ablation;
Laparoscopic ultrasound;
Three-dimentional reconstruction
- From:
Chinese Journal of Surgery
2016;54(9):692-699
- CountryChina
- Language:Chinese
-
Abstract:
Objective To discuss the significance of three-dimensional reconstruction as a method of preoperative planning of laparoscopic radiofrequency ablation (LRFA).Methods Thirty-two cases of LRFA admitted from January 2014 to December 2015 in Department of Hepatobiliary Surgery,Chinese People's Liberation Army General Hospital were analyzed (3D-LRFA group).Three-dimensional (3D) reconstruction were taken as a method of preoperative planning in 3D-LRFA group.Other 64 LRFA cases were paired over the same period without three-dimensional reconstruction before the operation (LRFA group).Hepatobiliary system contrast enhanced CT scan of 3D-RFA patients were taken by multi-slice spiral computed tomography(MSCT),and the DICOM data were processed by IQQA(R)-Liver and IQQA(R)-guide to make 3D reconstruction.Using 3D reconstruction model,diameter and scope of tumor were measured,suitable size (length and radiofrequency length) and number of RFA electrode were chosen,scope and effect of radiofrequency were simulated,reasonable needle track (s) was planed,position and angle of laparoscopic ultrasound (LUS) probe was designed and LUS image was simulated.Data of operation and recovery were collected and analyzed.Data between two sets of measurement data were compared with t test or rank sum test,and count data with x2 test or Fisher exact probability test.Tumor recurrence rate was analyzed with the Kaplan-Meier survival curve and Log-rank (Mantel-Cox) test.Results Compared with LRFA group ((216.8±66.2) minutes,(389.1 ±183.4) s),3D-LRFA group ((173.3 ±59.4) minutes,(242.2 ± 90.8) s) has shorter operation time(t =-3.138,P =0.002) and shorter mean puncture time(t =-2.340,P =0.021).There was no significant difference of blood loss (P =0.170),ablation rate (P =0.871) and incidence of complications(P =1.000).Compared with LRFA group ((6.3 ± 3.9)days,(330 ± 102)U/L,(167 ±64) ng/L),3D-LRFA group ((4.3 ± 3.1) days,(285 ± 102) U/L,(139 ± 43) ng/L) had shorter post-operative stay(t =-2.527,P =0.016),less post-operation ALT changes (t =-2.038,P =0.048) and post-operative TNF-αt changes (t =-2.233,P =0.027).Disease-free survival between two groups was significantly different (x2 =4.049,P =0.046).Disease-free survival of 12 months survival rates were 77.6％ and 65.7％ in 3D-LRFA group and LRFA group,respectively.The median disease-free survival was 16.0 months in LRFA group and over 24.0 months in 3D-LRFA group.Conclusions Three-dimensional model of liver reconstruction based on image information is a powerful tool in liver surgery planning.It helps to simulate tumor location and vital tubular structure,make plan for interventional treatment,and therefore mean puncture time and operation time is shortened,influence on liver function is reduced,hospital stay is decreased and DFS is prolonged.
