Research on the application of 3D visualization-based technology to guide surgical plan for hepatic alveolar echinococcosis

doi:10.12140/j.issn.1000-7423.2024.06.007

Abstract

Abstract:

Objective Exploring the innovative application of 3D visualization technology in assisting the design of surgical treatment plans for hepatic alveolar echinococcosis (HAE). Methods Fifty HAE patients who underwent preoperative examination with 3D visualization technology at the Affiliated Hospital of Qinghai University from January 2020 to March 2023 were enrolled to participate the research. The patient’s raw data was transmitted to a human 3D visualization virtual surgical system to process 3D visual reconstruction modeling for determining the whole liver volume, planned liver resection volume, the liver volume to be reserved, and the hydatid lesion volume, thereby,the residual liver ratio was calculated, and compared with what actually seen in the operation to evaluate the application value of 3D visualization technology for HAE. Another 50 patients with HAE who did not undergo 3D visualization technology during the same period were selected as the control group. The control group received 2D enhanced CT imaging and precise liver resection. Compare the general and perioperative data between the two groups were compared and the generalized estimating equation (GEE) model was used to analyze the influencing factors on patients’ postoperative prognosis. Results There was no statistically significant difference in general information such as age, gender, body mass index (BMI), resection site, lesion diameter, excised liver volume, remaining liver volume, as well as differences in CT features and MRI imaging data between two groups of patients (P > 0.05). Compared with the control group, the study group had shorter surgical time [(228.56 ± 29.47) min], pringle method total liver block time [(26.65 ± 4.78) min], less intraoperative blood loss [(435.14 ± 98.76) ml], shorter hospital stay [(15.27 ± 2.13) days], lower hospitalization costs [(4.58 ± 0.79) yuan], and higher satisfaction with doctor-patient communication (89.65 ± 9.23) (t = 3.856, 3.561, 6.069, 3.561, 5.400, 3.812; all P < 0.05). The reconstructed 3D model can be rotated, scaled, and translated, and can also hide or render semi-transparent structures such as liver parenchyma, veins, and arteries, providing a clear and intuitive understanding of the spatial relationships between important anatomical structures and lesions in the liver. The average volume of planned liver resection predicted by 3D visualization technology is 2 154.43 ml, the average volume of reserved liver is 1 203.27 ml, and the average residual liver ratio is 41.22%. The average volume of liver resection during the operation was 2 138.75 ml, and the average volume of remaining liver was 1 193.46 ml. There was no statistically significant difference (t = 1.135, P > 0.05) between the estimated and actual liver volumes obtained through 3D visualization reconstruction. The GEE analysis results showed that the invasion of hepatic Echinococcus multilocularis edge infiltration and 3D visualization reconstruction significantly affected the prognosis of patients (χ² = 7.890, 3.876; P < 0.05). Conclusion Three dimensional visualization technology can be used to develop a rational liver resection plan for HAE patients before surgery, improving the success rate of surgery and enhancing patients’ prognosis.

Key words: Hepatic alveolar echinococcosis, Preoperative planning, 3D visualization technology, Prognosis

CLC Number:

R532.32

LI Zhenwei, WANG Cheng, WANG Zhixin, LIU Jinming, ZHAO Qian, WANG Haijiu, XIE Zhi. Research on the application of 3D visualization-based technology to guide surgical plan for hepatic alveolar echinococcosis[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2024, 42(6): 737-743.

Figures/Tables 6

Table 1

Table 2

Table 3

Fig. 1

Table 4

Table 5

Analysis of prognostic factors in patients with hepatic alveolar echinococcosis

项目 Project	β	SE	95% CI		参数估计 Parameter estimation			OR 95% CI
项目 Project	β	SE	上限 Upper limits	下限 Lower limits	Wald χ²	OR	P	上限 Upper limits	下限 Lower limits
肝多房棘球蚴边缘浸润带 Marginal infiltrative zone of hepatic E. multilocularis	0.987	0.456	1.645	0.328	7.890	2.682	0.005	4.756	1.378
切除部位 Removal site	0.123	0.100	0.321	-0.075	1.485	1.130	0.223	1.382	0.885
病灶直径 Diameter of lesion	-0.087	0.098	0.023	-0.197	0.789	0.917	0.375	1.025	0.812
切除肝脏体积 Liver resection volume	0.045	0.067	0.157	-0.067	0.456	1.046	0.500	1.158	0.934
剩余肝脏体积 Remaining liver volume	0.234	0.156	0.545	-0.077	2.345	1.263	0.126	1.645	0.928
手术时间 Surgical duration	0.156	0.145	0.446	0.006	1.456	1.169	0.228	1.678	1.006
出血量 Bleeding volume	-0.567	0.345	-0.078	1.056	6.012	0.568	0.064	0.876	1.324
术后住院时间 Postoperative hospitalization time	0.002	0.045	0.094	-0.090	0.009	1.002	0.925	1.107	0.905
Pringle法全肝阻断时间 Pringle method whole liver block time	-0.012	0.034	0.050	-0.074	0.112	0.988	0.738	1.040	0.934
住院费用 Hospitalization expenses	0.056	0.067	0.189	-0.077	0.632	1.057	0.427	1.221	0.923
分型 Classification	0.023	0.089	0.191	-0.145	0.063	1.023	0.802	1.130	0.889
病灶大小 Disease size	0.012	0.090	0.204	-0.180	0.017	1.012	0.897	1.125	0.890
瘤周强化 Peritumoral enhancement	0.045	0.067	0.177	-0.087	0.456	1.046	0.500	1.155	0.937
边缘表现 Edge performance	-0.023	0.045	0.045	-0.111	0.289	0.977	0.590	1.079	0.876
瘤周低信号 Low signal around the tumor	0.067	0.089	0.245	-0.111	0.587	1.070	0.444	1.287	0.890
强化方式 Strengthening methods	-0.009	0.045	0.037	-0.095	0.041	0.991	0.840	1.033	0.902
增强类型 Enhanced type	0.045	0.089	0.223	-0.137	0.267	1.046	0.605	1.200	0.891
T1WI	1.038	0.423	0.447	1.273	6.023	2.824	0.062	1.564	3.571
T2WI	0.468	0.213	-0.449	0.776	4.817	1.596	0.162	0.638	2.173
三维可视化重建 3D visualization reconstruction	-0.378	0.192	-0.794	-0.122	3.876	0.685	0.025	0.452	0.885

Table 5

References 17

[1]	Feng XB, Shang H, Lu Q, et al. Comment on “the value of hepatic vein stent placement as a bridge therapy on treating hepatic alveolar echinococcosis presenting with budd-chiari syndrome”[J]. Ann Surg, 2021, 273(4): e157-e158.
[2]	Li HL, Bao HH, Fan HN, et al. CT features of hepatic alveolar echinococcosis invading venous vessels[J]. Chin High Alt Med Biol, 2021, 42(4): 269-272. (in Chinese)
	(栗海龙, 鲍海华, 樊海宁, 等. 肝泡型包虫病侵犯静脉血管的CT特征征象[J]. 中国高原医学与生物学杂志, 2021, 42(4): 269-272.)
[3]	Wen J, Li Q, Zhang X, et al. Advances in the diagnosis and treatment of hepatic alveolar echinococcosis[J]. J Gastrointest Surg, 2023, 27(5): 987-996.
[4]	Wang T, Liu C, Yang Y, et al. The role of immunotherapy in the management of advanced hepatic alveolar echinococcosis[J]. Clin Infect Dis, 2022, 71(10): 2431-2438.
[5]	Gottstein B, Stieger B, Ackermann E, et al. Current insights into the pathogenesis and treatment of hepatic alveolar echinococcosis[J]. Parasitology, 2021, 148(S1): S11-S24.
[6]	Miao J, Yang W, Chen X, et al. Vascular invasion in hepatic alveolar echinococcosis: an imaging-based review[J]. Radiology, 2023, 298(1): 156-165.
[7]	Shen S. Expert consensus on diagnosis and treatment of alveolar echinococcosis (2020 edition)[J]. Chin J Bas Clin Gen Surg, 2020, 27(1): 13-17. (in Chinese)
	(沈舒. 泡型肝包虫病诊疗专家共识(2020版)[J]. 中国普外基础与临床杂志, 2020, 27(1): 13-17.)
[8]	Wang C, Qiu YW, Wang WT. Application of ex vivo liver resection and autotransplantation in treating budd-chiari syndrome secondary to end-stage hepatic alveolar echinococcosis: a case series[J]. Medicine (Baltimore), 2021, 100(34): e27075.
[9]	Zhang L, Wang H, Liu Y, et al. Radical hepatectomy for hepatic alveolar echinococcosis: complications and long-term outcomes[J]. Surg Endosc, 2022, 36(11): 5476-5485.
[10]	Wang Y, Chen J, Ma H, et al. Advances in imaging diagnosis and interventional treatment of hepatic alveolar echinococcosis[J]. J Vasc Interv Radiol, 2021, 32(10): 1492-1502.
[11]	Schantz PM, Craig PS, Ito A, et al. Echinococcosis: an emerging and re-emerging parasitic zoonosis[J]. Int J Parasitol, 2023, 53(1): 25-43.
[12]	Han S, Kui Y, Xue CZ, et al. The endemic status of echinococcosis in China from 2004 to 2020[J]. Chin J Parasitol Parasit Dis, 2022, 40(4): 475-480. (in Chinese)
	(韩帅, 蒉嫣, 薛垂召, 等. 2004—2020年全国棘球蚴病疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(4): 475-480.) doi: 10.12140/j.issn.1000-7423.2022.04.009
[13]	Yang W, Miao J, Wen J, et al. Surgical strategies for hepatic alveolar echinococcosis with major vascular involvement: areview[J]. World J Gastroenterol, 2023, 29(15): 1779-1790.
[14]	Piazuelo MB, Carmena D, Moro PL, et al. Hepatic alveolar echinococcosis: a review of current management strategies[J]. J Gastrointest Surg, 2023, 27(11): 2233-2242.
[15]	Gloor S, Jiang WJ, Maurer MH, et al. The trajectory of anti-recEm18 antibody levels determines follow-up after curative resection of hepatic alveolar echinococcosis[J]. HPB(Oxford), 2024, 26(2): 224-233.
[16]	Zhou P, Wang Q, Zhang W, et al. Advances in radiological imaging of hepatic alveolar echinococcosis: a comprehensive review[J]. J Med Imag Radiat Oncol, 2023, 57(2): 175-184.
[17]	Yan Z, Zhao BW, Lin GY, et al. Clinical application of imaging three-dimensional visualization technique in guidance of hepatectomy in patients with hepatocellular carcinoma[J]. J Pract Hepatol, 2024, 27(3): 438-441. (in Chinese)
	(闫振, 赵博文, 林国英, 等. 影像学三维可视化技术指导肝切除术治疗肝细胞癌患者临床疗效研究[J]. 实用肝脏病杂志, 2024, 27(3): 438-441.)

项目Project	研究组患者（n = 50） Patients in research group (n = 50)	对照组患者（n = 50） Patients in control group (n = 50)	t/χ²	P
年龄/岁 Age/Year	43.15 ± 4.37	43.23 ± 4.25	0.072	0.943
性别 Gender			0.05	0.823
男 Male	26（52.00%）^a	24（48.00%）^a
女 Female	24（48.00%）^a	26（52.00%）^a
体质量指数/kg•m^-2 BMI/kg•m^-2	23.35 ± 2.98	23.41 ± 3.34	0.02	0.984
肝多房棘球蚴边缘浸润带 Marginal infiltrative zone of hepatic Echinococcus multilocularis			0.363	0.547
有侵犯 Infringement	23（46.00%）^a	24（48.00%）^a
无侵犯 No infringement	27（54.00%）^a	26（52.00%）^a
切除部位 Removal site			1.958	0.581
左半肝切除 Left hemihepatectomy	13（26.00%）^a	14（28.00%）^a
左半肝切除 + 肝门棘球蚴切除 Left hemihepatectomy + hepatic portal echinococcectomy	10（20.00%）^a	13（26.00%）^a
右半肝切除 Right hemihepatectomy	10（20.00%）^a	7（14.00%）^a
右半肝切除 + 肝门棘球蚴切除 Right hemihepatectomy + hepatic portal echinococcectomy	13（26.00%）a	12（24.00%）a
解剖性肝段切除 Anatomical liver segmentectomy	4（8.00%）a	4（8.00%）a
病灶直径/cm Diameter of lesion/cm	8.24 ± 1.16	8.37 ± 1.22	0.001	0.970
切除肝脏体积/ml Liver resection volume/ml	2 138.75 ± 157.94	2 129.42 ± 148.73	0.353	0.725
剩余肝脏体积/ml Remaining liver volume/ml	1 193.46 ± 85.73	1 215.63 ± 91.48	0.125	0.693

项目 Project	研究组例数（占比/%）（n = 50） No. research group case (Proportion/%) (n = 50)	对照组例数（占比/%）（n = 50） No. control group case (Proportion/%) (n = 50)	t/χ²	P
CT特征 CT feature
分型 Classification			0.294	0.770
结节型 Nodular type	16（32.00）	19（38.00）
巨块型 Giant block typae	22（44.00）	20（40.00）
弥漫型 Diffuse type	12（24.00）	11（22.00）
病灶大小/cm Disease size/cm			0.214	0.648
< 5	27（54.00）	25（50.00）
≥ 5	23（46.00）	25（50.00）
瘤周强化 Peritumoral enhancement			0.113	0.739
是 Yes	31（62.00）	29（58.00）
否 No	19（38.00）	21（42.00）
边缘表现 Edge performance			0.321	0.572
光滑 Smooth	14（28.00）	13（26.00）
不光滑 Not smooth	36（72.00）	37（74.00）
瘤周低信号 Low signal around the tumor			0.182	0.671
是 Yes	26（52.00）	22（44.00）
否 No	24（48.00）	28（56.00）
强化方式 Strengthening method			0.328	0.567
典型 Typical	27（54.00）	25（50.00）
不典型 Not typical	23（46.00）	25（50.00）
增强类型 Enhanced type			0.42	0.518
均匀 Uniformity	18（36.00）	16（32.00）
不均匀 Uneven	32（64.00）	34（68.00）
MRI
T1WI			0.625	0.430
稍低信号 Slightly lower signal	13（26.00）	11（22.00）
等信号 Middle signal	20（40.00）	24（48.00）
稍高信号 Slightly high signal	17（34.00）	15（30.00）
T2WI			0.222	0.638
稍低信号 Slightly lower signal	9（18.00）	13（26.00）
等信号 Middle signal	22（44.00）	19（38.00）
稍高信号 Slightly high signal	19（38.00）	18（36.00）

项目 Project	研究组（n = 50） Research group (n = 50)	对照组（n = 50） Control group (n = 50)	t/χ²	P
手术时间/min Surgical duration/min	228.56 ± 29.47	284.32 ± 24.89	3.856	<0.001
出血量/ml Bleeding volume/ml	435.14 ± 98.76	517.45 ± 88.65	6.069	0.014
术后住院时间/d Postoperative hospitalization time/d	15.27 ± 2.13	16.43 ± 2.98	3.561	0.037
Pringle法全肝阻断时间/min Pringle method whole liver block time/min	26.65 ± 4.78	33.98 ± 3.91	5.4	0.023
住院费用/万元 Hospitalization expenses/10 000 yuan	4.58 ± 0.79	4.79 ± 0.92	2.627	0.01
医患沟通满意度 Satisfaction with doctor-patient communication	89.65 ± 9.23	81.50 ± 10.49	3.812	<0.001

项目 Project	研究组患者 Patients in research group
肝脏体积/ml Liver volume/ml	3 354.52 ± 174.96
棘球蚴病灶体积/ml Volume of Echinococcus lesion/ml	6 771.95 ± 365.45
预留肝脏体积/ml Reserved liver volume/ml	1 203.27 ± 98.23
预切肝脏体积/ml Pre cut liver volume/ml	2 154.43 ± 136.52
残肝比 Residual liver ratio/%	41.22 ± 6.38
实际切除肝脏体积/ml Actual volume of liver resection/ml	2 138.75 ± 157.94
实际剩余肝脏体积/ml Actual remaining liver volume/ml	1 193.46 ± 85.73