Objective:To study the use of three-dimensional reconstruction in preoperative evaluation of complicated hepatic echinococcosis in Tibet.Methods:Sixty patients with complex hepatic hydatidosis admitted to the People's Hospital of Tibet Autonomous Region from April 2020 to August 2020 and planned to undergo radical hepatectomy were enrolled in this prospective randomized controlled study. The patients were randomly divided into the preoperative CT group and preoperative 3D reconstruction group by computer generated random numbers, with 30 patients in each group. Those with odd random numbers were enrolled in the preoperative CT group, and those with even random numbers were enrolled in the preoperative 3D reconstruction group. According to the imaging results, the operation plan was developed, and the coincidence rates of the preoperation plan with intraoperative decision, and postoperative complications were compared between the two groups.Results:There were 27 males and 33 females, aged (40.7±12.7) years. In the preoperative CT group, 53.3% (16/30) of the operation carried out were consistent with the preoperative planned operations. The corresponding figure for the preoperative 3D reconstruction group was 86.7% (26/30). The difference between the two groups was significant ( P<0.05). In the preoperative CT group, the operative time was (220.0±32.3) min, the intraoperative blood loss was (523.0±47.1) ml, the number of patients requiring hepatic blood inflow occlusion was 25 (83.3%), and the time of hepatic blood inflow occlusion was (32.1±5.8) min. In the preoperative 3D reconstruction group, the operative time was (156.0±17.6) min, the intraoperative blood loss was (212.0±21.5) ml, the number of patients requiring of hepatic blood inflow occlusion was 15 (50.0%), and the time of hepatic blood inflow occlusion was (16.2±3.4) min. The differences between the two groups were also significant (all P<0.05). Conclusion:Preoperative three-dimensional reconstruction of complex hepatic echinococcosis in Tibet effectively improved the safety of surgery.