Application of digital three-dimensional reconstruction in liver transplantation for hepatic alveolar echinocoecosis

Objective To investigate the application value of digital three-dimensional reconstruction in liver transplantation for hepatic alveolar echinocoecosis (HAE). Methods Clinical data of 21 patients with end-stage HAE undergoing liver transplantation (LT) and 6 living donors in the First Affiliated Hospital of Xinjiang Medical University between April 2012 and December 2014 were retrospectively studied. Among the 21 patients, 13 were males and 8 were females with the average age of (43±13) years old. Among the 6 donors, 4 were males and 2 were females with the average age of (40±9) years old. Fifteen cases underwent extracorporeal hepatectomy and autotransplantation and 6 cases underwent living donor LT. The informed consents of all patients and 6 living donors were obtained and the local ethical committee approval had been received. All patients and donors received computer tomography (CT) plain scan, 3-phase (arterial phase, portal venous phase and delayed phase) enhancement scan and computed tomography angiography (CTA). The total liver volume and the liver graft volume were measured according to the two-dimensional liver image. The digital three-dimensional liver reconstruction software was used to perform three-dimensional model reconstruction. The total liver volume and the liver graft volume were measured a second time. The liver section was designed and the individualized virtual surgery was performed. The actual total liver volume and the liver graft volume were measured during LT to assess the error rate of liver volume predicted before operation. The comparison of liver volume data was conducted using t test and the comparison of the error rate of liver graft volume was conducted using Chi-square test. Results The intrahepatic anatomical relationship was clearly displayed by the three-dimensional model, which was in accordance with that observed during operation. The liver graft volume of 15 patients undergoing extracorporeal hepatectomy and autotransplantation and 6 patients undergoing living donor LT calculated by the digital three-dimensional reconstruction technology was (766±197) ml, which was significantly smaller than (833±243) ml calculated by the two-dimensional measurement (t=-3.674, P<0.05). Compared with the actual liver graft volume of (955±194) ml measured during operation, the average error rate of the liver graft volume calculated by the three-dimensional reconstruction technology was (6±1) %, which was significantly smaller than (13±2) % of that calculated by two-dimensional measurement (t=-14.346, P<0.05). The liver graft volume measured by the three-dimensional measurement was positively correlated with the actual liver graft volume measured during operation (r=0.967, P<0.05). All the operations were completed successfully. One patient died of acute renal failure 12 d after LT. No case was observed developing liver failure or hemorrhage or other severe complications. The growth of the liver graft was good and the anastomotic stoma of intrahepatic vessels was clear by CT reexamination and three-dimensional reconstruction after operation. Conclusion The application of three-dimensional reconstruction technology in preoperative assessment and operation planning of LT for end-stage HAE can improve the precision and success rate and achieve good curative effect. Key words: Echinococcosis, hepatic; Echinococcus multilocularis; Liver transplantation; Imaging, three-dimensional; Surgery, computer-assisted