To investigate the application value of lasting methylene blue staining and three-dimensional reconstruction in precise anatomic hepatectomy for patients with liver cancer.

From January 2015 to December 2017, one hundred and thirty-four patients with liver cancer in the 901st Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army were enrolled. Three-phase enhanced CT or MRI were performed before operation, and three-dimensional reconstruction of portal vein, hepatic artery and hepatic vein was completed by MeVis software. Fifty-four patients underwent lasting methylene blue staining combined with precise anatomical hepatectomy (combined group, dosage of methylene blue was 4 ml per hepatic segment), and 80 patients underwent precise anatomical hepatectomy alone (control group). The perioperative indicators and 1-year cumulative survival rate were compared between the two groups after follow-up until December 2018.

In the combined group, 53 cases (98.15%) had the same intraoperative liver staining as hepatic angiography. Compared with the control group, patients of the combined group had longer operation time and less bleeding during operation (t=7.424, 2.923; P=0.009, 0.023). There were no significant differences in the time of hepatic hilar occlusion, incidence of complications between the two groups (t=0.317, P=0.261; 18.52% vs 17.50%, χ²=0.016, P=0.900). Tumor margins were negative in both groups. There was no significant difference in the average hospitalization time between the combined group and the control group [(7.45±3.17) d vs (6.64±4.36) d, t=1.172, P=0.331]. The abdominal drainage volume in the combined group was less than that in the control group two days before operation, and the difference was significant (t=5.382, 4.944; P=0.015, 0.033). Compared with the combined group, the serum alanine aminotransferase and total bilirubin levels in the control group were significantly higher on the 1st, 3rd day after operation, while the albumin levels were significantly lower on the 1st, 3rd and 5th day after operation (all P<0.05). There was no significant difference in 1-year cumulative survival rate between the two groups (90% vs 89%, P=0.806).

The lasting methylene blue staining can improve the accuracy of anatomic hepatectomy and reduce the intraoperative blood loss, which is conductive to making clear the liver segmental boundaries and improving the accuracy of operative section selection.

To investigate the application value of precise hepatectomy in primary liver cancer with portal vein tumor thrombi.

Clinical data of ten patients were analyzed retrospectively of liver cancer combined with portal vein tumor thrombi undergoing precise hepatectomy in Zhongshan City People’s Hospital between January 2013 and August 2014. The operation time, intraoperative hemorrhage volume, postoperative complications, postoperative length of hospital stay and follow-up data were recorded.

Hepatectomy was performed successfully in all patients. The incisional margins were detected as negative after tumor resection. No patients died during the perioperative period. The mean operation time was (292±45) min, intraoperative hemorrhage volume was (365±81) ml, postoperative length of hospital stay was (13±3) d. Two cases of pleural effusion postoperatively were cured by conservative treatment. Two patients suffered from tumor recurrence 4 months and 5 months after surgery respectively and died, and the rest recovered well.

The application of precise hepatectomy in primary liver cancer with portal vein tumor thrombi is safe and effective, with advantages of less intraoperative hemorrhage, lower incidence of complications, and faster postoperative recovery.

To explore the value of three-dimensional visualization technology in preoperative precise assessment for huge hepatic carcinoma (HCC).

The clinical data of twenty-five patients with giant HCC who were admitted to Chenggong Hospital Affiliated to Xiamen University from January 2013 to January 2015 were retrospectively analyzed. Based on simulated hepatectomy and three-dimensional visualization technology, the two-dimensional images of CT were converted into three-dimensional images. Preoperative assessment was done by measuring the volume of liver, tumor, pre-resection liver and residual liver. For patients undergoing operation, volume of the predicted resected liver and the results of the actual liver resection was calculated for a correlation test analysis.

All the liver tissues, tumor tissues and the hepatic vessels were reconstructed successfully using the three-dimensional reconstruction software. Twenty patients underwent accurate assessment followed by precise operation. The volume of simulated resected liver was (1 856.10±255.85) ml, while the actual liver resection volume was (1 817.02±251.17) ml. There was no significant difference between the predicted and the actual values (t=0.487, P>0.05). The actual liver resection volume was positively correlated with the predicted liver resection volume (r=0.972, P<0.05).

The three-dimensional visualization technology has a certain degree of clinical value in the precision before giant hepatocellular carcinoma surgery.

To investigate the effects of fast-track surgery (FTS) combined with precise liver resection for perioperative care in patients undergoing liver resection.

A prospective study of 345 patients undergoing FTS together with precise liver resection was performed from Jan 2009 to Jan 2014. The patients were divided randomly into traditional group and FTS group. C-reactive protein (CRP), serum cortisol, blood glucose and other blood serum index were tested. Discharging time after operation, eating time, anus exhausting time, complications, hospital stay, and hospital fee were recorded.

FTS group had obvious less changes than control group in cortisol and blood glucose after operation (P<0.05). And the out-of-bed, eating, anus exhausting time of FTS with precise liver resection group were significantly ahead of control group (P<0.05). FTS group also had shortened hospital days, decreased hospitalization fees, and no increased complications and readmission rate.

Fast-track surgery with precise liver resection is safe and effective for recommendation of liver resection.

To evaluate the safety and efficacy of precise hepatectomy techniques in hepatolithus.

Ninety-two patients with hepatolithus undergoing hepatectomy from January 2008 to October 2012 were reviewed retrospectively. Thirty-two patients received irregular hepatectomy (control group) and 60 received precise hepatectomy (experimental group), and the intraoperative and postoperative indexes such as operative time, intraoperative blood loss, postoperative liver function, length of hospital stay, incidence of complications and clearance rate of calculus were analyzed.

In experimental group, the operative time was longer [(262.2±54.2)min vs (174.8 ±54.8)min, t=30.727, P<0.01], but the patients had reduced intraoperative blood loss [(438.5±89.6)ml vs (680.6±74.7)ml, t=-86.465, P<0.01], faster recovery of liver function [ALT value on POD 7, (50.1±7.4) U/L vs (320.7±11.8) U/L, t=-96.470, P<0.01], less postoperative complications(11.7% vs 40.6%, χ²=10.227, P<0.01), higher clearance rate of calculus(100.0% vs 75.0%, χ²=16.429, P<0.01)and shortened length of hospital stay [(15.9±5.4) d vs(23.4±4.3) d, t=-50.103, P<0.01].

Precise hepatectomy is safe and effective in the treatment of hepatolithus without much injury to patients. Precise hepatectomy can significantly decrease postoperative complications, length of hospital stay, and accelerate the early rehabilitation.