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Abstract：
OBJECTIVE: Complications after laparoscopic liver resection (LLR) are important factors affecting the prognosis of patients, especially for complex hepatobiliary diseases. The present study aimed to evaluate the value of a three-dimensional (3D) printed dry-laboratory model in the precise planning of LLR for complex hepatobiliary diseases.
METHODS: Patients with complex hepatobiliary diseases who underwent LLR were preoperatively enrolled, and divided into two groups according to whether using a 3D-printed dry-laboratory model (3D vs. control group). Clinical variables were assessed and complications were graded by the Clavien-Dindo classification. The Comprehensive Complication Index (CCI) scores were calculated and compared for each patient. Multivariable analysis was performed to determine the risk factors of postoperative complications.
RESULTS: Sixty-two patients with complex hepatobiliary diseases underwent the precise planning of LLR. Among them, thirty-one patients acquired the guidance of a 3D-printed dry-laboratory model, and others were only guided by traditional enhanced CT or MRI. The results showed no significant differences between the two groups in baseline characters. However, compared to the control group, the 3D group had a lower incidence of intraoperative blood loss, as well as postoperative 30-day and major complications, especially bile leakage (all P < 0.05). The median score on the CCI was 20.9 (range 8.7-51.8) in the control group and 8.7 (range 8.7-43.4) in the 3D group (mean difference, -12.2, P = 0.004). Multivariable analysis showed the 3D model was an independent protective factor in decreasing postoperative complications. Subgroup analysis also showed that a 3D model could decrease postoperative complications, especially for bile leakage in patients with intrahepatic cholelithiasis.
CONCLUSIONS: The 3D-printed models can help reduce postoperative complications. The 3D-printed models should be recommended for patients with complex hepatobiliary diseases undergoing precise planning LLR.
METHODS: Patients with complex hepatobiliary diseases who underwent LLR were preoperatively enrolled, and divided into two groups according to whether using a 3D-printed dry-laboratory model (3D vs. control group). Clinical variables were assessed and complications were graded by the Clavien-Dindo classification. The Comprehensive Complication Index (CCI) scores were calculated and compared for each patient. Multivariable analysis was performed to determine the risk factors of postoperative complications.
RESULTS: Sixty-two patients with complex hepatobiliary diseases underwent the precise planning of LLR. Among them, thirty-one patients acquired the guidance of a 3D-printed dry-laboratory model, and others were only guided by traditional enhanced CT or MRI. The results showed no significant differences between the two groups in baseline characters. However, compared to the control group, the 3D group had a lower incidence of intraoperative blood loss, as well as postoperative 30-day and major complications, especially bile leakage (all P < 0.05). The median score on the CCI was 20.9 (range 8.7-51.8) in the control group and 8.7 (range 8.7-43.4) in the 3D group (mean difference, -12.2, P = 0.004). Multivariable analysis showed the 3D model was an independent protective factor in decreasing postoperative complications. Subgroup analysis also showed that a 3D model could decrease postoperative complications, especially for bile leakage in patients with intrahepatic cholelithiasis.
CONCLUSIONS: The 3D-printed models can help reduce postoperative complications. The 3D-printed models should be recommended for patients with complex hepatobiliary diseases undergoing precise planning LLR.
摘要：
目的：腹腔镜肝切除术（LLR）后并发症是影响患者预后的重要因素。尤其是复杂的肝胆疾病。本研究旨在评估三维（3D）打印干实验室模型在复杂肝胆疾病的LLR精确规划中的价值。
方法：术前纳入接受LLR治疗的复杂肝胆疾病患者，并根据是否使用3D打印的干实验室模型分为两组(3D与对照组)。评估临床变量，并通过Clavien-Dindo分类对并发症进行分级。计算并比较每位患者的综合并发症指数（CCI）评分。采用多因素分析确定术后并发症的危险因素。
结果：62例复杂肝胆疾病患者接受了LLR的精确规划。其中,31名患者获得了3D打印干实验室模型的指导，其他人仅在传统增强CT或MRI引导下。结果表明，两组在基线特征上没有显着差异。然而,与对照组相比，3D组术中失血发生率较低，以及术后30天和主要并发症，尤其是胆漏(均P<0.05)。对照组的CCI中位数为20.9（范围8.7-51.8），3D组为8.7（范围8.7-43.4）（平均差，-12.2,P=0.004)。多变量分析显示3D模型是减少术后并发症的独立保护因素。亚组分析还显示，3D模型可以减少术后并发症，尤其是肝内胆石症患者的胆漏。
结论：3D打印模型有助于减少术后并发症。3D打印模型应推荐用于接受精确规划LLR的复杂肝胆疾病患者。
方法：术前纳入接受LLR治疗的复杂肝胆疾病患者，并根据是否使用3D打印的干实验室模型分为两组(3D与对照组)。评估临床变量，并通过Clavien-Dindo分类对并发症进行分级。计算并比较每位患者的综合并发症指数（CCI）评分。采用多因素分析确定术后并发症的危险因素。
结果：62例复杂肝胆疾病患者接受了LLR的精确规划。其中,31名患者获得了3D打印干实验室模型的指导，其他人仅在传统增强CT或MRI引导下。结果表明，两组在基线特征上没有显着差异。然而,与对照组相比，3D组术中失血发生率较低，以及术后30天和主要并发症，尤其是胆漏(均P<0.05)。对照组的CCI中位数为20.9（范围8.7-51.8），3D组为8.7（范围8.7-43.4）（平均差，-12.2,P=0.004)。多变量分析显示3D模型是减少术后并发症的独立保护因素。亚组分析还显示，3D模型可以减少术后并发症，尤其是肝内胆石症患者的胆漏。
结论：3D打印模型有助于减少术后并发症。3D打印模型应推荐用于接受精确规划LLR的复杂肝胆疾病患者。
