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To explore the construction and clinical efficacy of three-dimensional(3D) visualization platform about diagnosis and treatment of hilar cholangiocarcinoma.
From January 2009 to December 2015, a total of 32 patients with hilarcholangiocarcinoma treated in Zhujiang Hospital of Southern Medical University were analyzed.There were 20 male and 12 female patients aged from 40 to 85 years. Bismuth-Corlette 3D visualization type: 2 cases with type Ⅰ, 5 cases with type Ⅱ, 10 cases with type Ⅲa, 11 cases with type Ⅲb, 4 cases with type Ⅳ.Among 32 cases, there were 5 cases who were established liver 3D printing models to guide intraoperative real-time navigation.The clinical effect of this platform was evaluated by the operation time, intraoperative blood loss, laboratory test and postoperative complications.The 3D visualization platform consists of the preoperative surgical planning with the aid of virtual 3D reconstruction technology and intraoperative real-time navigation with 3D printing models.
The liver 3D models for all patients were constructed successfully, they could clearly show intrahepatic pipeline, size and location of tumors, relationship between tumor and intrahepatic pipeline.The 3D printing models could accomplish real-time intraoperative navigation surgery with strong stereoscopic sense.According to Bismuth classification 3D visualization type, 2 patients with type Ⅰ received local excision of tumor and choledochojejunostomy; 5 patients with type Ⅱ received resection of segment Ⅰ, Ⅳb and partial Ⅴ combined with choledochojejunostomy; 10 patients with type Ⅲa received right semi-hepatectomy combined with resection of segment Ⅰ and choledochojejunostomy; 11 cases with type Ⅲb received left semi-hepatectomy combined with resection of segment Ⅰ and choledochojejunostomy; 4 cases with type Ⅳ received resection of segment Ⅳb and Ⅴ combined with choledochojejunostomy.The operation time was 270-660 minutes; the mean intraoperative blood loss was 588 ml; the mean postoperative hospital stay was 25 days.The bilirubin level three day after operation was 233 μmol/L.There was 1 case presented biliary fistula and cured by conservative treatment; there was no incision infection, no liver failure and no perioperative deaths occurred.
The 3D visualization is valuable for optimizing the operation scheme preoperatively and navigating surgery accurately intraoperatively in real-time which may improve the precision of the operation and achieve better the recovery.