Application value of Three-Dimensional (3D) visualization technology in precise hepatectomy of primary liver cancer

Application value of Three-Dimensional (3D) visualization technology in precise hepatectomy of primary liver cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application value of Three-Dimensional (3D) visualization technology in precise hepatectomy of primary liver cancer Ning Zhang, Chunlong Shao, Rongyu Shi, Xiucheng Xue, Han Li, Quan Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9217437/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Objective: To explore the application value of Three-Dimensional (3D) visualization technology in precise hepatectomy for primary liver cancer. Methods: A total of 70 patients with primary liver cancer admitted to our hospital from May 2019 to May 2022 were selected as research objects, and were randomly divided into control group and study group, with 35 cases in each group. The control group was treated with routine precision hepatectomy, while the study group was treated with precision hepatectomy guided by 3D visualization technology. Liver volume, surgical indexes, liver function indexes, serum biochemical indexes, complications, recurrence rate, and mortality were observed and compared. Results: There was no significant difference in the proportion of total liver volume, lesion volume, liver resection volume and residual liver volume between 2 groups (P>0.05). Operation time, hepatic blood flow blocking time, intraoperative blood transfusion volume, intraoperative blood loss, anal exhaust time and hospital stay in the study group were significantly lower than those in the control group (P<0.05). After treatment, ALT, AST and ALB levels in both groups were lower than before treatment, and TBIL levels were higher than before treatment. ALT, AST and ALB levels in the study group were significantly lower than those in the control group, and TBIL levels were significantly higher than those in the control group (P<0.05). After treatment, the levels of AFP, TSGF, CYFRA21-1 and GGT in both groups were lower than before treatment, and the levels of AFP, TSGF, CYFRA21-1 and GGT in the study group were significantly lower than those in the control group (P<0.05). After treatment, the complication rate of the study group was 11.43%, which was significantly higher than that of the control group 37.14% (P<0.05). After treatment, the recurrence rate of the study group was 25.71%, which was significantly lower than that of the control group (40.00%) (P 0.05). Conclusion: The application of 3D visualization technology in precise hepatectomy for primary liver cancer can effectively remove the lesion tissue, improve liver function and lesion tissue, reduce the incidence of postoperative complications, recurrence rate and mortality, and obtain a better prognosis. three-dimensional visualization technology Primary liver cancer Precise hepatectomy Liver function security Figures Figure 1 Figure 2 Figure 3 Introduction Primary liver cancer is a common malignant tumor in China. According to the epidemiological statistics [ 1 ], it ranks the sixth in the incidence of malignant tumors worldwide and the third in the mortality rate, with up to 854,000 new cases per year and 466,000 cases in China, accounting for about 55%. It is predicted that the average annual number of new cases of the disease will increase by approximately 55% from 2020 to 2040, making it a serious threat to global public health. Notably, in China, due to its high incidence, it has become one of the leading causes of death. At present, the prevention and treatment of liver cancer has become the key prevention project in China [ 2 ]. Because the early symptoms and signs of the disease are not significant, it is often easily ignored or misdiagnosed, including significant appetite loss, fatigue, fever, and so on. The typical symptoms of the disease are often found in the middle and late stages, and the disease progresses rapidly, showing liver pain, digestive tract diseases, emaciation, jaundice, ascites, and so on [ 3 – 4 ]. Therefore, it is generally recommended in clinic that early detection and timely treatment are important measures to improve the prognosis of patients with primary liver cancer. Surgery is a common and effective treatment for primary liver cancer, which can effectively control the disease development and prolong its survival time. To further enhance the therapeutic efficacy and safety of liver resection, in 2006, Professor Dong first proposed the concept of "precise liver surgery" to the medical field. As an advanced surgical approach that has gradually emerged in recent years, precise hepatectomy is centered on accurately resecting tumor tissue, while maximizing the preservation of functional liver parenchyma, maintaining the integrity of key blood vessels and biliary structures, minimizing surgical trauma, and achieving optimal patient recovery. Its key procedural steps encompass preoperative assessment, simulated planning of the resection plane, real‑time intraoperative navigation, and meticulous dissection along predefined anatomical boundaries [ 5 ]. However, despite these technological advancements, certain clinical challenges persist in clinical practice: some patients undergoing hepatectomy are prone to damage liver organs when severing the liver parenchyma during the operation due to tumor cell adhesion or invasion of surrounding important blood vessels and nerve tissues. In other patients, the trauma during the operation is larger, and they are prone to liver failure after the operation, which affects the prognosis [ 6 – 7 ]. Relevant studies have shown that the incidence of complications after hepatectomy is as high as 23.40%–40.00%, and the postoperative mortality is as high as 1.60%–7.55%, indicating a high risk [ 8 ]. Therefore, to improve the safety and efficiency of surgery, it is urgent to accurately evaluate the location of focal tissues and the anatomical structure of the liver before surgery, formulate a sound plan and accurately resect the tumor cells. In order to improve the location, size and blood supply of tumor, clinical imaging examinations are often used to analyze images and master the basic information of tumor cells and tissues, but conventional two-dimensional planar examinations are difficult to reflect the tumor vascular orientation, internal piping system and three-dimensional spatial structure [ 9 – 10 ]. As a new type of abdominal medical imaging technology, three-dimensional visualization technology can clearly and intuitively grasp the three-dimensional anatomy, morphology and characteristics of abdominal focal tissues, and has been widely used in abdominal surgery [ 11 ]. Reports on precision hepatectomy for patients with primary liver cancer in China and abroad mostly focus on the optimization of surgical scheme and the refinement of surgical instruments, and there is still debate on the application effect of three-dimensional visualization technology in precision hepatectomy [ 12 ]. In summary, the objective of this study was to assess the application value of three-dimensional visualization technology in precise hepatectomy for primary liver cancer. To this end, 70 patients were enrolled and randomly allocated to two groups, undergoing either 3D visualization-guided or conventional precise hepatectomy. Through systematic comparative analysis of liver volume parameters, surgery-related indicators, liver function indicators, levels of serum tumor markers, incidence of postoperative complications, tumor recurrence rate, and mortality between the two groups, we expect to provide objective evidence-based medical support for the clinical promotion and application of this technology. Material and methods 1.1 General material In this study, 70 patients with primary liver cancer who were admitted to our hospital from May 2019 to May 2022 were selected as the research subjects. They were randomly divided into the control group and the study group, with 35 cases in each group. There was no significant difference in general information such as gender and age between the two groups (P > 0.05). The control group received routine precise hepatectomy treatment, while the study group received precise hepatectomy treatment under the guidance of three-dimensional visualization technology. This study was approved by the Medical Ethics Committee of the hospital. 1.2 Criteria of inclusion and exclusion Inclusion criteria: ① Patients met the diagnostic criteria of primary liver cancer in the Guideline for Standardized Pathological Diagnosis of Primary Liver Cancer (2015 Version) [ 13 ]; ② Primary liver cancer is confirmed through imaging examination and histopathological examination; ③ Patients with Child-Pugh grade A or B of liver function, and those with KPS score ≥ 60 points; Estimated survival time ≥ 3 months; ④ Hepatectomy is performed for the first time, with no contraindication to surgery; ⑤ Those who had not received radiotherapy or chemotherapy for liver cancer; ⑥ Patients without cognitive impairment or mental disorder and with normal communication function; ⑦ The subjects and relatives were informed of the research content and signed informed consent form voluntarily. Exclusion criteria: ① Patients with severe heart, kidney, lung and other organ dysfunction or other malignant tumors; ② Patients with distant metastasis or invasion of the first and second hilar regions were excluded; ③ Patients with severe jaundice, bleeding tendency, and gastrointestinal abnormalities; ④ patients with coagulation disorders and immunodeficiency; ⑤ Patients with abnormal reduction of leukocyte and platelet levels; ⑥ Patients who lost contact or failed to cooperate with treatment during follow-up. 1.3 Research methods 1.3.1 Preoperative evaluation and surgical planning : ① All patients filled in the basic information after enrollment and received preoperative examinations, including liver function biochemical tests, coagulation tests, cardiopulmonary function, CT enhanced scans, etc. According to the 64-slice CT enhanced scan images of the upper abdomen, the spatial relationship between the lesion tissue and the surrounding tissues and blood vessels was analyzed, whether there was invasion of the first and second porta hepatis and surrounding tissues, and the surgical plan was proposed and roughly estimated, which was adjusted in combination with intraoperative conditions. ② In the study group, the enhanced CT scan data were imported into three-dimensional reconstruction software, and after extracting the image information of liver parenchyma, duct, and tumor, the spatial structure of liver parenchyma, arteriovenous vessels, and the relationship between each duct were reconstructed. According to the rendering tools provided by the system, including lights, materials, and colors, each structure and vessel in the liver were disassembled, combined, and transparent, and the lesion tissue and the relationship with the duct were observed at multiple angles. In the three-dimensional visualization technique, the location, size, blood supply and invasion of the liver are clarified, the whole liver volume, the expected resected liver volume and the residual liver volume are calculated, and the surgical plan and pre-tangent are designed. After repeated operation and drills, the maximum residual liver volume is retained as far as possible, and the residual liver volume can meet the postoperative compensation of the body, and the final surgical plan is designed. Remaining liver volume ratio = Remaining liver volume/standard liver volume × 100%. The surgical plan should meet the criteria: the remaining liver volume of normal liver parenchyma accounts for > 30%; if fibrosis, liver cirrhosis, fatty liver, viral hepatitis and other conditions occur, the remaining liver volume accounts for > 40%; if the above criteria cannot be met, the surgical plan should be reformulated [ 14 ] (Fig. 1 ). 1.3.2 Surgical methods ① Routine precise hepatectomy in the control group: tumor cell invasion, resection volume and residual liver volume were assessed according to the results of preoperative enhanced CT scan.After combined intravenous anesthesia via airway intubation, take the supine position, assist the patient to be in a comfortable surgical position according to the tumor location, maintain the head height foot base position 15 °, left or right inclination 15 ~ 30 °, separate the feet; establish carbon dioxide pneumoperitoneum, maintain pneumoperitoneum pressure 13 ~ 15 mmHg, use five-port laparoscopic hepatectomy, use 2 cm below the umbilicus as the observation hole, establish Trocar, select the tumor cell position and determine the operation hole, use harmonic scalpel to sequentially remove the ligamentum teres hepatis and falciform ligament hepatis, then along the tumor cell 1 cm position for resection, send for examination after resection, electrocoagulation hemostasis, clean the wound surface and stop bleeding, use line 5.0 to suture the wound for patients with more bleeding surfaces.② The study group underwent precise hepatectomy guided by three-dimensional visualization technique: the preoperative three-dimensional liver model was brought into the operating room as a real-time reference, and the operation was performed after the hepatectomy plane and volume were finally determined.Surgical anesthesia and body position were the same as those in the control group.Under the guidance of three-dimensional visualization technique, the first porta hepatis was dissected, the left and right hepatic arteries, portal veins, etc. were freed and blocked, and then the second porta hepatis was separated, and the superior and inferior hepatic vena cava were fully freed and blocked. Use fluorescence equipment to scan the liver surface, observe the tumor tissue, boundary and tiny lesion tissue. According to the surgical plan established by preoperative three-dimensional visualization technique, perform resection along the pre-tangent line. After the tumor cells are completely removed, submit for examination to determine whether there is bleeding and bile leakage in the liver section. Electrocoagulation is used to stop bleeding, clean the wound surface and stop bleeding, place a drainage tube, and suture the trauma. 1.3.3 Postoperative treatment After operation, the patient was given anti-infection, analgesia, liver protection, acid suppression and nutritional support, and regularly received blood routine, coagulation examination and liver function biochemical examination. Patients were followed up for a total period of 6 months postoperatively. During this period, follow-up assessments were conducted monthly via text messages, phone calls, or home visits. 1.4 Observational index ① Comparison of liver volumes: The total liver volume, lesion volume, hepatectomy volume, and the proportion of remaining liver volume in the two groups were compared. ② Surgical indicators: The operation time, hepatic blood flow blocking time, intraoperative blood transfusion, intraoperative blood loss, anal exhaust time and hospital stay of the two groups were observed. ③ Liver function indicators: The full-automatic biochemical analyzer (Hitachi Co., Ltd., model 7170A, Japan) was used to detect the liver function indicators before treatment and one week after treatment, including alanine transaminase (ALT), aspartate transaminase (AST), albumin (ALB), and Total bilirubin (TBIL). ④ Serum biochemical indicators: ELISA was used to detect the serum biochemical indicators before treatment and one week after treatment, including α-fetoprotein (AFP), tumor specific growth factor (TSGF) and keratin 19 fragment (CYFRA21-1). The kit was provided by Shanghai Hengfei Biotechnology Co., Ltd.; Gamma-Glutamyl Transferase (GGT) was detected by polyacrylamide gel electrophoresis. ⑤ Complications: The adverse reactions, including pleural effusion, bile leakage, intra-abdominal infection, pulmonary infection, and intestinal obstruction, were assessed according to the National Cancer Institute General Criteria for Adverse Events (NCI-CTTCAE) Version 3.0 [ 15 ]. ⑥ Recurrence rate and mortality rate: After two years of follow-up, the tumor recurrence rate and mortality rate of the two groups were recorded. The tumor recurrence criteria were as follows: the edge of the diseased tissue was involved, and the edge of the diseased tissue or the presence of the diseased tissue out of the incised edge or within 1mm from the tissue to the incised edge could be seen in the high-power view. 1.5 Statistical analysis SPSS 24.0 statistical software was used. The data conforming to the normal distribution were measured and expressed as ( ± s). The data between groups were compared with t test. Enumeration data were expressed as case number (N) and percentage (%). Intergroup comparison was performed using χ2 test, and P < 0.05 indicated that the difference had statistical significance. Results 2.1 Comparison of basic data between the two groups The results showed that there was no significant difference in basic data such as gender, age, BMI, hepatitis history, tumor diameter, tumor characteristics, tumor location, and Child-pugh grading between the two groups (P > 0.05), as shown in Table 1 . Table 1 Comparison of basic data between the two groups Group Control group (n = 35) Study group (n = 35) t value P value Gender (cases) Male 24(68.57) 22(62.86) 5.623 0.194 Female 11(31.43) 13(37.14) Age(years) 57.42 ± 4.62 57.99 ± 4.38 7.618 0.417 BMI(kg/m 2 ) 23.51 ± 1.23 23.58 ± 1.24 7.094 0.684 Hepatitis history (cases) 31(88.57) 30(85.71) 4.540 0.198 Tumor diameter(cm) 6.84 ± 2.06 6.81 ± 2.03 4.903 0.745 Tumor characteristics (cases) Single 29(82.86) 30(85.71) 3.986 0.174 Multiple 6(17.14) 5(14.29) Tumor location (cases) Left 16(45.71) 15(42.86) 6.384 0.069 Right 19(54.29) 20(57.14) Child-pugh grading (cases) GradeA 28(80.00) 26(74.29) 4.966 0.072 Grade B 7(20.00) 9(25.71) 2.2 Comparison of liver volume between the two groups The results showed that there was no significant difference in total liver volume, lesion volume, hepatectomy volume and the proportion of remaining liver volume between the two groups (P > 0.05), as shown in Table 2 . Table 2 Comparison of liver volume between the two groups( ±s) Group Control group (n = 35) Study group (n = 35) P value Total liver volume(cm 3 ) 1549.65 ± 453.26 1671.23 ± 429.35 0.2533 Lesion volume(cm 3 ) 284.36 ± 215.20 283.65 ± 243.26 0.9897 Hepatectomy volume(cm 3 ) 566.39 ± 248.62 541.26 ± 234.74 0.6651 Proportion of remaining liver volume(%) 63.95 ± 16.38 63.84 ± 15.84 0.9773 2.3 Comparison of surgical indexes between the two groups The results showed that the operation time, hepatic inflow occlusion time, intraoperative blood transfusion volume, intraoperative bleeding volume, anal exhaust time, and hospital stay in the study group were significantly lower than those in the control group, and the differences were statistically significant (P < 0.05), as shown in Table 3 . Table 3 Comparison of surgical indexes between the two groups( ±s) Group Control group (n = 35) Study group (n = 35) P value Operation time (min) 419.66 ± 98.74 309.62 ± 82.04 # < 0.001 Hepatic inflow occlusion time (min) 26.95 ± 7.27 18.94 ± 6.33 # < 0.001 Intraoperative blood transfusion volume (mL) 482.26 ± 81.39 344.17 ± 73.20 # < 0.001 Intraoperative bleeding volume (mL) 543.62 ± 118.64 376.51 ± 94.81 # < 0.001 Anal exhaust time (h) 88.65 ± 21.29 70.95 ± 15.36 # 0.0002 Hospital stay (d) 10.95 ± 2.41 8.73 ± 1.03 # < 0.001 Note, compared with the control group, # P < 0.001。 2.4 Comparison of liver function indexes between the two groups The results showed that there was no significant difference in the levels of ALT, AST, ALB and TBIL between the two groups before treatment (P > 0.05). After treatment, the ALT, AST, and ALB levels of patients in the two groups were lower than those before treatment, while the TBIL level was higher than that before treatment. The ALT, AST, and ALB levels of the study group were significantly lower than those of the control group, while the TBIL level was significantly higher than that of the control group. The differences were statistically significant (P < 0.05), as shown in Table 4 and Fig. 2 . Table 4 Comparison of liver function indexes between the two groups( ±s) Group Time Control group (n = 35) Study group (n = 35) ALT (U/L) Before treatment 76.95 ± 11.64 79.62 ± 12.84 After treatment 60.83 ± 9.75* 45.81 ± 3.67* # AST (U/L) Before treatment 46.38 ± 10.54 46.39 ± 10.37 After treatment 37.99 ± 7.65* 26.84 ± 6.38* # ALB (g/L) Before treatment 40.65 ± 5.31 40.51 ± 5.30 After treatment 37.61 ± 4.83* 31.34 ± 3.91* # TBIL (µmol/L) Before treatment 19.35 ± 1.74 19.44 ± 1.76 After treatment 21.94 ± 1.98* 29.65 ± 2.09* # Note, compared with before treatment, *P < 0.05; Compared with the control group, #P < 0.05. 2.5 Comparison of serum biochemical indexes between the two groups The results showed that there was no significant difference in the levels of AFP, TSGF, CYFRA21-1 and GGT between the two groups before treatment (P > 0.05). After treatment, the levels of AFP, TSGF, CYFRA21-1 and GGT in the two groups were lower than those before treatment. The levels of AFP, TSGF, CYFRA21-1 and GGT in the study group were significantly lower than those in the control group with statistically significant differences (P < 0.05), as shown in Table 5 and Fig. 3 . Table 5 Comparison of serum biochemical indexes between the two groups( ±s) Group Time Control group (n = 35) Study group (n = 35) AFP (µg/L) Before treatment 132.95 ± 30.86 132.66 ± 30.79 After treatment 20.62 ± 2.67* 4.59 ± 0.63* # TSGF (U/mL) Before treatment 107.62 ± 12.96 107.63 ± 12.67 After treatment 98.34 ± 10.64* 75.38 ± 5.38* # CYFRA21-1 (ng/L) Before treatment 12.95 ± 2.64 12.96 ± 2.69 After treatment 6.34 ± 1.52* 4.73 ± 1.02* # GGT (IU/L) Before treatment 543.51 ± 122.05 545.37 ± 119.37 After treatment 357.62 ± 82.36* 109.36 ± 25.32* # Note, compared with before treatment, *P < 0.05; Compared with the control group, #P < 0.05. 2.6 'Comparison of complications between the two groups The results showed that the incidence of complications in the study group was 11.43% after treatment, significantly higher than 37.14% in the control group. The difference was statistically significant (P < 0.05), as shown in Table 6 . Table 6 Comparison of complications between the two groups (cases, %) Group Control group (n = 35) Study group (n = 35) χ2 value P value Pleural effusion 5(14.29) 2(5.71) - - Bile leakage 2(5.71) 1(2.86) - - Abdominal infection 2(5.71) 0(0.00) - - Lung infection 1(2.86) 0(0.00) - - Ileus 3(8.57) 1(2.86) - - Incidence of complication 37.14% 11.43% 5.362 0.001 2.7 Comparison of recurrence rate and mortality between the two groups The results showed that the recurrence rate of 25.71% in the treatment group was significantly lower than 40.00% in the control group and the difference was statistically significant (P 0.05), as shown in Table 7 . Table 7 Comparison of recurrence rate and mortality between the two groups (cases, %) Group Control group (n = 35) Study group (n = 35) χ2 value P value Reoccurrence 14 (40.00) 9 (25.71) 3.263 0.005 Mortality 8 (22.86) 3 (8.57) 3.956 0.126 Discussion Primary liver cancer, as a malignant tumor occurring in hepatocytes and intrahepatic bile duct epithelial cells, has become the second highest incidence of malignant tumor in China, with the mortality rate second only to that of gastric cancer and esophageal cancer. With the change of lifestyle, the incidence rate of this disease increases year by year, which has seriously threatened the life safety of the people [16]. The pathogenic factors and pathogenesis of this disease are relatively complex and cannot be fully elucidated so far. It is generally believed that liver cells are excessively regenerated due to liver cirrhosis and hepatitis, of which hepatitis B is the most common. In addition, long-term smoking and alcohol abuse will have a toxic effect on liver cells, causing decomposition and metabolism of fatty acids to be abnormal, and fat accumulation in the liver to further develop into liver fibrosis and liver cancer. In addition, irregular diet, long-term consumption of moldy food and lack of trace elements also promoted the occurrence of liver cancer [17–18]. For the clinical treatment plan of this disease, targeted treatment is often given according to the stage and severity of the disease. However, due to the lack of donor liver source, the immature social medical system, and the limited family economic level, the majority of patients choose hepatectomy for treatment [19]. Some studies [20] have pointed out that with the continuous improvement of imaging technology and interventional therapy, the perioperative mortality of hepatectomy is lower than 5%, but the five-year survival rate is still less than 50%. Therefore, how to improve the surgical effect and prognosis of primary liver cancer is a major problem to be solved. As a brand-new concept and technical treatment for liver cancer, precision hepatectomy advocates that minimally invasive surgery should be adopted to reduce the surgical trauma and preserve the normal liver tissue to the maximum extent so as to achieve the optimal surgical effect [21]. In recent years, three-dimensional visualization technology has been gradually applied to patients with liver cancer, but there is no clear conclusion about the clinical efficacy of three-dimensional visualization technology in precise hepatectomy [22]. Therefore, in this study, the use of three-dimensional visualization technology in precise hepatectomy for patients with primary liver cancer can significantly improve the therapeutic effect and safety, and is conducive to improving the prognosis, providing new ideas for the optimization of surgical treatment options for diseases. During the occurrence and development of primary liver cancer, not only pathophysiological changes occur in liver tissues, but also high differentiation and distant metastasis of tumor cells may occur. Liver function indicators and serum biochemical indicators play vital roles in the above processes, and changes in relevant levels can sensitively reflect liver function, lesion tissue conditions, etc. Primary liver cancer cells will stimulate the normal liver cell function, resulting in abnormally high and released ALT, AST, and ALB into the blood, decreased TBIL level, and increased liver metabolic burden, etc. [23]. Serum AFP is mainly increased due to continuous damage of liver cells and limited regeneration and differentiation ability, which can sensitively evaluate tumor progression of patients with liver cancer. TSGF is a factor that increases the proliferation and growth of capillaries in and around the tumor during the formation and development of cancer cells, and can effectively judge the early formation and prognosis of tumors. CYFRA21-1 is mostly released into blood as dissolved fragments in normal tissues and cells with relatively low concentration. However, when the body is in a pathological change, it will stimulate the degradation of cytokeratin 19 and activate protease to cause its large release, reflecting the progression of liver cancer. GGT is present in the cytoplasm and epithelial cells of liver cells, and can sensitively identify the degree of differentiation, infiltration and residue of liver cancer cells [24–25]. Ruzzenente A et al. [26] used high-resolution three-dimensional technology to effectively evaluate liver anatomical features, tumor cells and vascular infiltration, to provide more detailed and targeted parameters for hepatectomy and to improve the accuracy of liver cancer resection. The results of this study showed that the operation time, hepatic blood flow blocking time, intraoperative blood transfusion, intraoperative blood loss, anal exhaust time and hospital stay in the study group were significantly lower than those in the control group. After treatment, the ALT, AST and ALB levels of patients in the two groups were lower than those before treatment, while the TBIL level was higher than those before treatment. The ALT, AST and ALB levels of the study group were significantly lower than those of the control group, while the TBIL level was significantly higher than that of the control group. After treatment, the levels of AFP, TSGF, CYFRA21-1 and GGT in patients of the two groups were lower than those before treatment. The levels of AFP, TSGF, CYFRA21-1 and GGT in the study group were significantly lower than those in the control group. The results were basically similar to those of the Ruzzenente A study, indicating that the use of three-dimensional visualization technology in precise hepatectomy for patients with primary liver cancer could effectively adjust the perioperative parameters, preserve the normal liver tissue as much as possible, and remove the focal tissue. The reason for that analysis may be that three-dimensional visualization technology is use to print and reconstruct the patient's liver tissue before the precise hepatectomy, the spatial anatomical relationship between tumor cell and normal liver tissue and vascular system are analyzed, the blood vessels on the hepatectomy surface are comprehensively analyze, the resection volume of focal tissue and the residual liver volume are calculated, whether the residual normal liver tissue can maintain postoperative liver compensation is evaluated, and the feasibility of a hepatectomy scheme is analyzed. It helps patients to master the vascular anatomy and tissue dissociation in the surgical resection scheme, shortens the operation time, reduces the operation bleeding and blood transfusion, preserves the normal liver tissue to the maximum extent, and promotes the individualized, minimally invasive and precise development of hepatectomy [27–28]. The liver is the most functional organ and tissue in the body, with rich blood flow channels and complex vascular system. In the past, surgeons mostly relied on two-dimensional planar images of CT and MRI examinations to assess the surgical plan and imagined three-dimensional images in mind. However, due to the limitation of personal experience, in addition to the abnormalities in the vascular system of some patients and the correlation between tumor blood supply system and the surgical resection surface, the surgical plan often had great risks and uncertainties, and it was prone to massive bleeding during the operation. Complications such as thoracic infection, abdominal infection, and biliary fistula occurred after the operation, and even the recurrence rate and mortality rate were high, affecting the overall prognosis [29]. Fang CH et al. [30] pointed out that three-dimensional visualization technology could accurately determine the anatomical location of primary liver cancer and the morphological characteristics of tumor cells, improve the success rate of accurate hepatectomy and reduce the risk of postoperative complications. The data of this study indicated that the incidence of complications in the study group after treatment was significantly higher than that in the control group. The recurrence rate in the treatment group was significantly lower than that in the control group. The results were basically consistent with those in the Fang CH literature, suggesting that the use of three-dimensional visualization technology in precise hepatectomy could effectively reduce the risk of postoperative complications and recurrence rate of patients with primary liver cancer and improve the treatment safety. Preoperative residual liver tissue and surgical method selection of primary liver cancer are closely related to the postoperative prognosis. In this paper, the functional liver volume, tumor volume and residual liver volume are accurately calculated by three-dimensional visualization technology, in combination with the location of tumor cells and blood supply of patients, to maximize the retention of the residual liver volume, reduce the intraoperative trauma degree, optimize the treatment strategy, and guide the intraoperative meticulous operation, thereby reducing the incidence of complications and improving the prognosis [31]. There are still some shortcomings in this study, which are mainly reflected in the small number of samples, the fact that no grouping analysis was conducted for liver cancer patients with different disease progression, and the fact that there might be some differences between the experimental results and the actual data to a certain extent would reduce the accuracy of the research results. We only explored the pathophysiological state of primary liver cancer, and did not discuss the effects on its psychological state and quality of life. Follow-up time is short. It is worth noting that in clinical practice, the “cure rate” of liver cancer is typically defined by long-term survival metrics such as the 5‑year overall survival or disease‑free survival rate [32]. Given the relatively short follow-up duration in this study, we did not directly calculate cure rates. Instead, recurrence and mortality rates were used as key intermediate endpoints to assess treatment efficacy and patient outcomes. These indicators are widely recognized as meaningful surrogates for assessing the success of surgical intervention and the likelihood of long‑term cure in oncologic surgery. Therefore, to address these limitations, it is necessary to further expand the sample size of the study, stratified and grouped research according to the different stages of the disease progression of the patients, extend the follow-up time to calculate the long-term survival related indicators such as 5-year overall survival rate, disease-free survival rate and cure rate, and expand the research dimension to include the psychological state and quality of life of the patients into the evaluation system. In addition, it is necessary to enhance the consistency between experimental data and clinical practice, so as to more comprehensively and accurately explore the application value of 3D visualization technology in precise hepatectomy. In summary, the application of 3D visualization technology in precise hepatectomy for primary liver cancer not only provides surgeons with clearer three-dimensional anatomical guidance, thereby helping to optimize surgical plans and intraoperative procedures, but also effectively shortens the operation time, reduces intraoperative blood loss, while lowering the incidence of postoperative complications and the tumor recurrence rate. Overall, 3D visualization technology is a valuable auxiliary tool in precise hepatectomy for primary liver cancer, and holds positive significance for improving patients' treatment outcomes. Declarations Ethical Approval and Consent to Participate This study was conducted in accordance with the Helsinki Declaration and relevant national/institutional ethical standards, with approval from the Ethics Committee of The First People’s Hospital of Jianshan (Approval No. 2025-EC-214). All participants provided informed consent accordingly. Clinical trial number Not applicable Data Availability Statement The data used to support the findings of this study are available from the corresponding author upon request. Funding None Conflicts of Interest The authors declared that they have no conflicts of interest regarding this work. References Liu Z , Suo C , Mao X ,et al. Global incidence trends in primary liver cancer by age at diagnosis, sex, region, and etiology, 1990-2017: Incidence trends in liver cancer with different diagnosed ages[J]. Cancer. 2020 , 15;126(10):2267-2278. Chen Y G , Yang C W , Chung C H ,et al. 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Luz J , Gomes F V , Costa N ,et al. BestFLR Trial: Liver Regeneration at CT before Major Hepatectomies for Liver Cancer-A Randomized Controlled Trial Comparing Portal Vein Embolization withN-Butyl-Cyanoacrylate Plus Iodized Oil versus Polyvinyl Alcohol Particles Plus Coils.[J]. Radiology. 2021 , 299(3):715-724. Liang J Y , Lin H C , Liu J ,et al. A novel prognostic nomogram for colorectal cancer liver metastasis patients with recurrence after hepatectomy[J]. Cancer Med. 2021 , 10(5):1535-1544. Griffiths CD, Xu K, Wang J, et al. Laparoscopic hepatectomy is safe and effective for the management of patients with colorectal cancer liver metastases in a population-based analysis in Ontario, Canada. A retrospective cohort study - ScienceDirect[J]. Int J Surg. 2020 , 83(6):47-52. Huang K , Zhang T , He Z ,et al. Comparison of Effects of Radiofrequency Ablation of Liver Cancer Guided by CT Images Based on Deep Learning Algorithm[J].Sci Program. 2021 , 2021(7): 7773473. Binder J S , Scholz M , Ellmann S ,et al.Cinematic Rendering in Anatomy: A Crossover Study Comparing a Novel 3D Reconstruction Technique to Conventional Computed Tomography[J]. Anat Sci Educ. 2021 , 14(1):22-31. Amandeep Kaur, Ajay Pal Singh Chauhan, Ashwani Kumar Aggarwal. An automated slice sorting technique for multi-slice computed tomography liver cancer images using convolutional network[J].Expert Systems with Applications, 2021 ,186(6):115686.1-115686.11. Cancer C S O L .Evidence-based practice guidelines for the standardized pathological diagnosis of primary liver cancer in China(2015 update)[J]. Zhonghua Gan Zang Bing Za Zhi. 2015 ,23(5):321-327. Araki K , Harimoto N , Ishii N ,et al. Usefulness of functional remnant liver volume assessment using EOB-MRI to predict posthepatectomy liver failure in hepatectomy of more than one segment[J]. HPB (Oxford). 2020 ,22(2):318-327. Zhong X , Lim E A , Hershman D L ,et al. ReCAP: Identifying Severe Adverse Event Clusters Using the National Cancer Institute's Common Terminology Criteria for Adverse Events[J]. J Oncol Pract. 2016 ,12(3):e270-280, Yuan S , Xie S H .Urban–rural disparity in cancer incidence in China, 2008–2012: A cross-sectional analysis of data from 36 cancer registers[J]. BMJ Open. 2021 , 30;11(4):e042762. Nault J C , Cheng A L , Sangro B ,et al. Milestones in the pathogenesis and management of primary liver cancer[J]. J Hepatol. 2020 , 72(2):209-214. Huang J , Patel H K , Lok V ,et al. IDDF2020-ABS-0156 Association between incidence and risk factors of liver cancer: a global country-level analysis[J]. Liver Cancer. 2021 ,10(4):330-345. Liu Y, Chen ZL, Yu XX,et al. Risk factors for hepatic insufficiency after major hepatectomy in non-cirrhotic patients[J]. Asian J Surg. 2021 ,44(10):1324-1325. Hellingman T , Kuiper B I , Buffart L M ,et al. Survival benefit of repeat local treatment in patients suffering from early recurrence of colorectal cancer liver metastases[J]. Clin Colorectal Cancer. 2021 ,20(4):263-272. Costa P F , Coelho F F , Jeismann V B ,et al. Repeat hepatectomy for recurrent colorectal liver metastases: A comparative analysis of short- and long-term results[J]. Hepatobiliary Pancreat Dis Int. 2022 , 21(2):162-167. Zheng J L , Xie W , Huang Y ,et al. The technique of 3D reconstruction combining with biochemistry to build an equivalent formula of indocyanine green (ICG) clearance test to assess the liver reserve function[J]. BMC Surg. 2020 , 12;20(1):283. Zhou L, Wang SB, Chen SG, et al. Prognostic Value of ALT, AST, and AAR in Hepatocellular Carcinoma with B-Type Hepatitis-Associated Cirrhosis after Radical Hepatectomy.[J]. Clin Lab. 2018 , 1;64(10):1739-1747. Sun L Y , Cen W J , Tang W T , et al. Alpha-Fetoprotein Ratio Predicts Alpha-Fetoprotein Positive Hepatocellular Cancer Patient Prognosis after Hepatectomy[J]. Dis Markers. 2022 , 11;2022(6):7640560. Cheng T, Chen J, Ying P, et al. Clinical risk factors of carbohydrate antigen-125, cytokeratin fragment 19, and neuron-specific enolase in liver metastases from elderly lung cancer patients[J]. Front Genet. 2022 , 29;13(9):1013253. Ruzzenente A, Alaimo L, Conci S, et al. Hyper accuracy three-dimensional (HA3D™) technology for planning complex liver resections: a preliminary single center experience[J]. Updates Surg. 2023 ,75(1):105-114. Ye R, Xie Y, Zhong D, et al. Effect of digital three-dimensional reconstruction technique combined with indocyanine green (ICG) excretion test for precision hepatectomy in primary liver cancer [J]. Am J Transl Res. 2023 , 15;15(5):3511-3520. Chinese SODM, Liver CCOCMDA, Clinical PMCOCMDA, et al. [Clinical practice guidelines for precision diagnosis and treatment of complex liver tumor guided by three-dimensional visualization technology (version 2019)] [J]. Nan Fang Yi Ke Da Xue Xue Bao. 2020 , 30;40(3):297-307. Wang J, Zhao JP, Wang JJ, et al. The impact of bile leakage on long-term prognosis in primary liver cancers after hepatectomy: A propensity-score-matched study[J]. Asian J Surg. 2020 ,43(5):603-612. Fang CH, Zhang P, Zhou WP, et al. [Efficacy of three-dimensional visualization technology in the precision diagnosis and treatment for primary liver cancer: a retrospective multicenter study of 1 665 cases in China] [J]. Zhonghua Wai Ke Za Zhi. 2020 , 1;58(5):375-382. Yang T, Lin S, Xie Q, et al. Impact of 3D printing technology on the comprehension of surgical liver anatomy[J]. Surg Endosc. 2019 ,33(2):411-417. Fei, F. R., Hu, R. Y., Gong, W. W., Pan, J., & Wang, M. (2019). Analysis of Mortality and Survival Rate of Liver Cancer in Zhejiang Province in China: A General Population-Based Study. Canadian journal of gastroenterology & hepatology, 2019, 1074286. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 22 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor invited by journal 27 Mar, 2026 Editor assigned by journal 26 Mar, 2026 Submission checks completed at journal 26 Mar, 2026 First submitted to journal 24 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9217437","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":630972746,"identity":"b3e90658-6062-44f8-81d1-ad69ec5c7495","order_by":0,"name":"Ning Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIiWNgGAWjYDAC/sbmBxIVNjz8/A3EapE43GZgcSZNRnLGAaKtSW+QqGw7bGPQkECkBt2Ggw0GN9jO8xgwHGD88DGHCC1mhxsbHs7guc1jztzALDlzGzFaDhxsMJaQuM1j2XCAjZmXOC2JDdJ/DM7xGBxIIEGLhETCAVK03DjYZiBxIJlHcsbBZiL9cr798QPJf3b2/PzNBz98JEYLEmBsIE39KBgFo2AUjALcAABy9TtOIs/LPwAAAABJRU5ErkJggg==","orcid":"","institution":"The First People’s Hospital of Jianshan","correspondingAuthor":true,"prefix":"","firstName":"Ning","middleName":"","lastName":"Zhang","suffix":""},{"id":630972747,"identity":"a0f80103-2a9c-4ccd-b113-a1865915563b","order_by":1,"name":"Chunlong Shao","email":"","orcid":"","institution":"The First People’s Hospital of Jianshan","correspondingAuthor":false,"prefix":"","firstName":"Chunlong","middleName":"","lastName":"Shao","suffix":""},{"id":630972748,"identity":"de213968-9f64-4e0a-9b47-5de0da2c658d","order_by":2,"name":"Rongyu Shi","email":"","orcid":"","institution":"The First People’s Hospital of Jianshan","correspondingAuthor":false,"prefix":"","firstName":"Rongyu","middleName":"","lastName":"Shi","suffix":""},{"id":630972749,"identity":"85866c7c-e8d4-46d9-98fa-1c0fe381cf79","order_by":3,"name":"Xiucheng Xue","email":"","orcid":"","institution":"The First People’s Hospital of Jianshan","correspondingAuthor":false,"prefix":"","firstName":"Xiucheng","middleName":"","lastName":"Xue","suffix":""},{"id":630972750,"identity":"818f2fac-3a72-459a-869d-283a96438c26","order_by":4,"name":"Han Li","email":"","orcid":"","institution":"The First People’s Hospital of Jianshan","correspondingAuthor":false,"prefix":"","firstName":"Han","middleName":"","lastName":"Li","suffix":""},{"id":630972751,"identity":"0afbd37f-4d47-40bd-9b72-75f6f7b3611b","order_by":5,"name":"Quan Wang","email":"","orcid":"","institution":"The First People’s Hospital of Jianshan","correspondingAuthor":false,"prefix":"","firstName":"Quan","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2026-03-25 03:08:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9217437/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9217437/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108182335,"identity":"1714f8a8-56a9-4907-a147-cfe798b26563","added_by":"auto","created_at":"2026-04-30 08:59:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":118890,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic workflow of the 3D visualization technology used in this study for precise hepatectomy planning. 3D images reconstructed from CT or MRI datasets can intuitively and stereoscopically visualize the spatial correlations between focal lesions and the intrahepatic vascular network.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9217437/v1/bea6a80cde8f62ac8be6c052.png"},{"id":108097862,"identity":"bc4a8980-39ba-412e-97d9-57c079c59fe8","added_by":"auto","created_at":"2026-04-29 10:17:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36724,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of liver function indexes between the two groups (A: ALT;B:AST;C:ALB;D:TBIL, Compared with before treatment, *P\u0026lt;0.05; Compared with the control group, #P\u0026lt;0.05.)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9217437/v1/1391e28d3dcaf5d630544104.png"},{"id":108182155,"identity":"34be98ca-0034-4f4c-95dd-a1ff0b364b78","added_by":"auto","created_at":"2026-04-30 08:59:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":36511,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of serum biochemical indexes between the two groups(A: AFP;B:TSGF;C:CYFRA21-1;D:GGT, Compared with before treatment, *P\u0026lt;0.05; Compared with the control group, #P\u0026lt;0.05.)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9217437/v1/d409a3d6fb95ef7230b7ff34.png"},{"id":108803946,"identity":"a2c02266-93b5-4943-a482-7a93f80bcd15","added_by":"auto","created_at":"2026-05-08 15:12:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":521683,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9217437/v1/9bed1522-2ef6-4e9c-b67a-8da6d26ba899.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application value of Three-Dimensional (3D) visualization technology in precise hepatectomy of primary liver cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePrimary liver cancer is a common malignant tumor in China. According to the epidemiological statistics [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], it ranks the sixth in the incidence of malignant tumors worldwide and the third in the mortality rate, with up to 854,000 new cases per year and 466,000 cases in China, accounting for about 55%. It is predicted that the average annual number of new cases of the disease will increase by approximately 55% from 2020 to 2040, making it a serious threat to global public health. Notably, in China, due to its high incidence, it has become one of the leading causes of death. At present, the prevention and treatment of liver cancer has become the key prevention project in China [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Because the early symptoms and signs of the disease are not significant, it is often easily ignored or misdiagnosed, including significant appetite loss, fatigue, fever, and so on. The typical symptoms of the disease are often found in the middle and late stages, and the disease progresses rapidly, showing liver pain, digestive tract diseases, emaciation, jaundice, ascites, and so on [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, it is generally recommended in clinic that early detection and timely treatment are important measures to improve the prognosis of patients with primary liver cancer.\u003c/p\u003e \u003cp\u003eSurgery is a common and effective treatment for primary liver cancer, which can effectively control the disease development and prolong its survival time. To further enhance the therapeutic efficacy and safety of liver resection, in 2006, Professor Dong first proposed the concept of \"precise liver surgery\" to the medical field. As an advanced surgical approach that has gradually emerged in recent years, precise hepatectomy is centered on accurately resecting tumor tissue, while maximizing the preservation of functional liver parenchyma, maintaining the integrity of key blood vessels and biliary structures, minimizing surgical trauma, and achieving optimal patient recovery. Its key procedural steps encompass preoperative assessment, simulated planning of the resection plane, real‑time intraoperative navigation, and meticulous dissection along predefined anatomical boundaries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, despite these technological advancements, certain clinical challenges persist in clinical practice: some patients undergoing hepatectomy are prone to damage liver organs when severing the liver parenchyma during the operation due to tumor cell adhesion or invasion of surrounding important blood vessels and nerve tissues. In other patients, the trauma during the operation is larger, and they are prone to liver failure after the operation, which affects the prognosis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Relevant studies have shown that the incidence of complications after hepatectomy is as high as 23.40%\u0026ndash;40.00%, and the postoperative mortality is as high as 1.60%\u0026ndash;7.55%, indicating a high risk [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, to improve the safety and efficiency of surgery, it is urgent to accurately evaluate the location of focal tissues and the anatomical structure of the liver before surgery, formulate a sound plan and accurately resect the tumor cells. In order to improve the location, size and blood supply of tumor, clinical imaging examinations are often used to analyze images and master the basic information of tumor cells and tissues, but conventional two-dimensional planar examinations are difficult to reflect the tumor vascular orientation, internal piping system and three-dimensional spatial structure [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. As a new type of abdominal medical imaging technology, three-dimensional visualization technology can clearly and intuitively grasp the three-dimensional anatomy, morphology and characteristics of abdominal focal tissues, and has been widely used in abdominal surgery [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Reports on precision hepatectomy for patients with primary liver cancer in China and abroad mostly focus on the optimization of surgical scheme and the refinement of surgical instruments, and there is still debate on the application effect of three-dimensional visualization technology in precision hepatectomy [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn summary, the objective of this study was to assess the application value of three-dimensional visualization technology in precise hepatectomy for primary liver cancer. To this end, 70 patients were enrolled and randomly allocated to two groups, undergoing either 3D visualization-guided or conventional precise hepatectomy. Through systematic comparative analysis of liver volume parameters, surgery-related indicators, liver function indicators, levels of serum tumor markers, incidence of postoperative complications, tumor recurrence rate, and mortality between the two groups, we expect to provide objective evidence-based medical support for the clinical promotion and application of this technology.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 General material\u003c/h2\u003e \u003cp\u003eIn this study, 70 patients with primary liver cancer who were admitted to our hospital from May 2019 to May 2022 were selected as the research subjects. They were randomly divided into the control group and the study group, with 35 cases in each group. There was no significant difference in general information such as gender and age between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The control group received routine precise hepatectomy treatment, while the study group received precise hepatectomy treatment under the guidance of three-dimensional visualization technology. This study was approved by the Medical Ethics Committee of the hospital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Criteria of inclusion and exclusion\u003c/h2\u003e \u003cp\u003eInclusion criteria: ① Patients met the diagnostic criteria of primary liver cancer in the Guideline for Standardized Pathological Diagnosis of Primary Liver Cancer (2015 Version) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; ② Primary liver cancer is confirmed through imaging examination and histopathological examination; ③ Patients with Child-Pugh grade A or B of liver function, and those with KPS score\u0026thinsp;\u0026ge;\u0026thinsp;60 points; Estimated survival time\u0026thinsp;\u0026ge;\u0026thinsp;3 months; ④ Hepatectomy is performed for the first time, with no contraindication to surgery; ⑤ Those who had not received radiotherapy or chemotherapy for liver cancer; ⑥ Patients without cognitive impairment or mental disorder and with normal communication function; ⑦ The subjects and relatives were informed of the research content and signed informed consent form voluntarily.\u003c/p\u003e \u003cp\u003eExclusion criteria: ① Patients with severe heart, kidney, lung and other organ dysfunction or other malignant tumors; ② Patients with distant metastasis or invasion of the first and second hilar regions were excluded; ③ Patients with severe jaundice, bleeding tendency, and gastrointestinal abnormalities; ④ patients with coagulation disorders and immunodeficiency; ⑤ Patients with abnormal reduction of leukocyte and platelet levels; ⑥ Patients who lost contact or failed to cooperate with treatment during follow-up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Research methods\u003c/h2\u003e \u003cp\u003e \u003cb\u003e1.3.1 Preoperative evaluation and surgical planning\u003c/b\u003e: ① All patients filled in the basic information after enrollment and received preoperative examinations, including liver function biochemical tests, coagulation tests, cardiopulmonary function, CT enhanced scans, etc. According to the 64-slice CT enhanced scan images of the upper abdomen, the spatial relationship between the lesion tissue and the surrounding tissues and blood vessels was analyzed, whether there was invasion of the first and second porta hepatis and surrounding tissues, and the surgical plan was proposed and roughly estimated, which was adjusted in combination with intraoperative conditions. ② In the study group, the enhanced CT scan data were imported into three-dimensional reconstruction software, and after extracting the image information of liver parenchyma, duct, and tumor, the spatial structure of liver parenchyma, arteriovenous vessels, and the relationship between each duct were reconstructed. According to the rendering tools provided by the system, including lights, materials, and colors, each structure and vessel in the liver were disassembled, combined, and transparent, and the lesion tissue and the relationship with the duct were observed at multiple angles. In the three-dimensional visualization technique, the location, size, blood supply and invasion of the liver are clarified, the whole liver volume, the expected resected liver volume and the residual liver volume are calculated, and the surgical plan and pre-tangent are designed. After repeated operation and drills, the maximum residual liver volume is retained as far as possible, and the residual liver volume can meet the postoperative compensation of the body, and the final surgical plan is designed. Remaining liver volume ratio\u0026thinsp;=\u0026thinsp;Remaining liver volume/standard liver volume \u0026times; 100%. The surgical plan should meet the criteria: the remaining liver volume of normal liver parenchyma accounts for \u0026gt;\u0026thinsp;30%; if fibrosis, liver cirrhosis, fatty liver, viral hepatitis and other conditions occur, the remaining liver volume accounts for \u0026gt;\u0026thinsp;40%; if the above criteria cannot be met, the surgical plan should be reformulated [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e1.3.2 Surgical methods\u003c/h2\u003e \u003cp\u003e① Routine precise hepatectomy in the control group: tumor cell invasion, resection volume and residual liver volume were assessed according to the results of preoperative enhanced CT scan.After combined intravenous anesthesia via airway intubation, take the supine position, assist the patient to be in a comfortable surgical position according to the tumor location, maintain the head height foot base position 15 \u0026deg;, left or right inclination 15\u0026thinsp;~\u0026thinsp;30 \u0026deg;, separate the feet; establish carbon dioxide pneumoperitoneum, maintain pneumoperitoneum pressure 13\u0026thinsp;~\u0026thinsp;15 mmHg, use five-port laparoscopic hepatectomy, use 2 cm below the umbilicus as the observation hole, establish Trocar, select the tumor cell position and determine the operation hole, use harmonic scalpel to sequentially remove the ligamentum teres hepatis and falciform ligament hepatis, then along the tumor cell 1 cm position for resection, send for examination after resection, electrocoagulation hemostasis, clean the wound surface and stop bleeding, use line 5.0 to suture the wound for patients with more bleeding surfaces.② The study group underwent precise hepatectomy guided by three-dimensional visualization technique: the preoperative three-dimensional liver model was brought into the operating room as a real-time reference, and the operation was performed after the hepatectomy plane and volume were finally determined.Surgical anesthesia and body position were the same as those in the control group.Under the guidance of three-dimensional visualization technique, the first porta hepatis was dissected, the left and right hepatic arteries, portal veins, etc. were freed and blocked, and then the second porta hepatis was separated, and the superior and inferior hepatic vena cava were fully freed and blocked. Use fluorescence equipment to scan the liver surface, observe the tumor tissue, boundary and tiny lesion tissue. According to the surgical plan established by preoperative three-dimensional visualization technique, perform resection along the pre-tangent line. After the tumor cells are completely removed, submit for examination to determine whether there is bleeding and bile leakage in the liver section. Electrocoagulation is used to stop bleeding, clean the wound surface and stop bleeding, place a drainage tube, and suture the trauma.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e1.3.3 Postoperative treatment\u003c/h2\u003e \u003cp\u003eAfter operation, the patient was given anti-infection, analgesia, liver protection, acid suppression and nutritional support, and regularly received blood routine, coagulation examination and liver function biochemical examination. Patients were followed up for a total period of 6 months postoperatively. During this period, follow-up assessments were conducted monthly via text messages, phone calls, or home visits.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Observational index\u003c/h2\u003e \u003cp\u003e① Comparison of liver volumes: The total liver volume, lesion volume, hepatectomy volume, and the proportion of remaining liver volume in the two groups were compared. ② Surgical indicators: The operation time, hepatic blood flow blocking time, intraoperative blood transfusion, intraoperative blood loss, anal exhaust time and hospital stay of the two groups were observed. ③ Liver function indicators: The full-automatic biochemical analyzer (Hitachi Co., Ltd., model 7170A, Japan) was used to detect the liver function indicators before treatment and one week after treatment, including alanine transaminase (ALT), aspartate transaminase (AST), albumin (ALB), and Total bilirubin (TBIL). ④ Serum biochemical indicators: ELISA was used to detect the serum biochemical indicators before treatment and one week after treatment, including α-fetoprotein (AFP), tumor specific growth factor (TSGF) and keratin 19 fragment (CYFRA21-1). The kit was provided by Shanghai Hengfei Biotechnology Co., Ltd.; Gamma-Glutamyl Transferase (GGT) was detected by polyacrylamide gel electrophoresis. ⑤ Complications: The adverse reactions, including pleural effusion, bile leakage, intra-abdominal infection, pulmonary infection, and intestinal obstruction, were assessed according to the National Cancer Institute General Criteria for Adverse Events (NCI-CTTCAE) Version 3.0 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. ⑥ Recurrence rate and mortality rate: After two years of follow-up, the tumor recurrence rate and mortality rate of the two groups were recorded. The tumor recurrence criteria were as follows: the edge of the diseased tissue was involved, and the edge of the diseased tissue or the presence of the diseased tissue out of the incised edge or within 1mm from the tissue to the incised edge could be seen in the high-power view.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e1.5 Statistical analysis\u003c/h2\u003e \u003cp\u003eSPSS 24.0 statistical software was used. The data conforming to the normal distribution were measured and expressed as (\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u0026plusmn;\u0026thinsp;s). The data between groups were compared with t test. Enumeration data were expressed as case number (N) and percentage (%). Intergroup comparison was performed using χ2 test, and P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated that the difference had statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Comparison of basic data between the two groups\u003c/h2\u003e \u003cp\u003eThe results showed that there was no significant difference in basic data such as gender, age, BMI, hepatitis history, tumor diameter, tumor characteristics, tumor location, and Child-pugh grading between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of basic data between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003e(cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(68.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22(62.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(31.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13(37.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.99\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHepatitis history (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(88.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30(85.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTumor diameter(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.81\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTumor characteristics\u003c/p\u003e \u003cp\u003e(cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(82.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30(85.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultiple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(17.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(14.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTumor location\u003c/p\u003e \u003cp\u003e(cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(45.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15(42.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(54.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20(57.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChild-pugh grading (cases)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGradeA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28(80.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26(74.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(20.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9(25.71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Comparison of liver volume between the two groups\u003c/h2\u003e \u003cp\u003eThe results showed that there was no significant difference in total liver volume, lesion volume, hepatectomy volume and the proportion of remaining liver volume between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of liver volume between the two groups(\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u0026plusmn;s)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal liver volume(cm\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1549.65\u0026thinsp;\u0026plusmn;\u0026thinsp;453.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1671.23\u0026thinsp;\u0026plusmn;\u0026thinsp;429.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2533\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion volume(cm\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e284.36\u0026thinsp;\u0026plusmn;\u0026thinsp;215.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e283.65\u0026thinsp;\u0026plusmn;\u0026thinsp;243.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9897\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatectomy volume(cm\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e566.39\u0026thinsp;\u0026plusmn;\u0026thinsp;248.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e541.26\u0026thinsp;\u0026plusmn;\u0026thinsp;234.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6651\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of remaining liver volume(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e63.95\u0026thinsp;\u0026plusmn;\u0026thinsp;16.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e63.84\u0026thinsp;\u0026plusmn;\u0026thinsp;15.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9773\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Comparison of surgical indexes between the two groups\u003c/h2\u003e \u003cp\u003eThe results showed that the operation time, hepatic inflow occlusion time, intraoperative blood transfusion volume, intraoperative bleeding volume, anal exhaust time, and hospital stay in the study group were significantly lower than those in the control group, and the differences were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of surgical indexes between the two groups(\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u0026plusmn;s)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e419.66\u0026thinsp;\u0026plusmn;\u0026thinsp;98.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e309.62\u0026thinsp;\u0026plusmn;\u0026thinsp;82.04\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatic inflow occlusion time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e26.95\u0026thinsp;\u0026plusmn;\u0026thinsp;7.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood transfusion volume (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e482.26\u0026thinsp;\u0026plusmn;\u0026thinsp;81.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e344.17\u0026thinsp;\u0026plusmn;\u0026thinsp;73.20\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative bleeding volume (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e543.62\u0026thinsp;\u0026plusmn;\u0026thinsp;118.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e376.51\u0026thinsp;\u0026plusmn;\u0026thinsp;94.81\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnal exhaust time (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e88.65\u0026thinsp;\u0026plusmn;\u0026thinsp;21.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e70.95\u0026thinsp;\u0026plusmn;\u0026thinsp;15.36\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital stay (d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote, compared with the control group, \u003csup\u003e#\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001。\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Comparison of liver function indexes between the two groups\u003c/h2\u003e \u003cp\u003eThe results showed that there was no significant difference in the levels of ALT, AST, ALB and TBIL between the two groups before treatment (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). After treatment, the ALT, AST, and ALB levels of patients in the two groups were lower than those before treatment, while the TBIL level was higher than that before treatment. The ALT, AST, and ALB levels of the study group were significantly lower than those of the control group, while the TBIL level was significantly higher than that of the control group. The differences were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of liver function indexes between the two groups(\u003c/b\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003cb\u003e\u0026plusmn;s)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003cp\u003e(U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e76.95\u0026thinsp;\u0026plusmn;\u0026thinsp;11.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e79.62\u0026thinsp;\u0026plusmn;\u0026thinsp;12.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e60.83\u0026thinsp;\u0026plusmn;\u0026thinsp;9.75*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e45.81\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003cp\u003e(U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46.38\u0026thinsp;\u0026plusmn;\u0026thinsp;10.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e46.39\u0026thinsp;\u0026plusmn;\u0026thinsp;10.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e37.99\u0026thinsp;\u0026plusmn;\u0026thinsp;7.65*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e26.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.38*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eALB\u003c/p\u003e \u003cp\u003e(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e40.65\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e40.51\u0026thinsp;\u0026plusmn;\u0026thinsp;5.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e37.61\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e31.34\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTBIL\u003c/p\u003e \u003cp\u003e(\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e19.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e21.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e29.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote, compared with before treatment, *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Compared with the control group, #P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Comparison of serum biochemical indexes between the two groups\u003c/h2\u003e \u003cp\u003eThe results showed that there was no significant difference in the levels of AFP, TSGF, CYFRA21-1 and GGT between the two groups before treatment (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). After treatment, the levels of AFP, TSGF, CYFRA21-1 and GGT in the two groups were lower than those before treatment. The levels of AFP, TSGF, CYFRA21-1 and GGT in the study group were significantly lower than those in the control group with statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eComparison of serum biochemical indexes between the two groups(\u003c/b\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003cb\u003e\u0026plusmn;s)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAFP\u003c/p\u003e \u003cp\u003e(\u0026micro;g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e132.95\u0026thinsp;\u0026plusmn;\u0026thinsp;30.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e132.66\u0026thinsp;\u0026plusmn;\u0026thinsp;30.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e20.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTSGF\u003c/p\u003e \u003cp\u003e(U/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e107.62\u0026thinsp;\u0026plusmn;\u0026thinsp;12.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e107.63\u0026thinsp;\u0026plusmn;\u0026thinsp;12.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e98.34\u0026thinsp;\u0026plusmn;\u0026thinsp;10.64*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e75.38\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCYFRA21-1\u003c/p\u003e \u003cp\u003e(ng/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e6.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e4.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGGT\u003c/p\u003e \u003cp\u003e(IU/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e543.51\u0026thinsp;\u0026plusmn;\u0026thinsp;122.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e545.37\u0026thinsp;\u0026plusmn;\u0026thinsp;119.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e357.62\u0026thinsp;\u0026plusmn;\u0026thinsp;82.36*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e109.36\u0026thinsp;\u0026plusmn;\u0026thinsp;25.32*\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote, compared with before treatment, *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Compared with the control group, #P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e2.6 'Comparison of complications between the two groups\u003c/h2\u003e \u003cp\u003eThe results showed that the incidence of complications in the study group was 11.43% after treatment, significantly higher than 37.14% in the control group. The difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of complications between the two groups (cases, %)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ2 value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePleural effusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(14.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(5.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBile leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(5.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(2.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(5.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(2.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(8.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(2.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncidence of complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37.14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.43%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Comparison of recurrence rate and mortality between the two groups\u003c/h2\u003e \u003cp\u003eThe results showed that the recurrence rate of 25.71% in the treatment group was significantly lower than 40.00% in the control group and the difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The mortality rate of 8.57% was significantly lower than that of the control group (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of recurrence rate and mortality between the two groups (cases, %)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ2 value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReoccurrence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (40.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (25.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (22.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (8.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.956\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrimary liver cancer, as a malignant tumor occurring in hepatocytes and intrahepatic bile duct epithelial cells, has become the second highest incidence of malignant tumor in China, with the mortality rate second only to that of gastric cancer and esophageal cancer. With the change of lifestyle, the incidence rate of this disease increases year by year, which has seriously threatened the life safety of the people [16]. The pathogenic factors and pathogenesis of this disease are relatively complex and cannot be fully elucidated so far. It is generally believed that liver cells are excessively regenerated due to liver cirrhosis and hepatitis, of which hepatitis B is the most common. In addition, long-term smoking and alcohol abuse will have a toxic effect on liver cells, causing decomposition and metabolism of fatty acids to be abnormal, and fat accumulation in the liver to further develop into liver fibrosis and liver cancer. In addition, irregular diet, long-term consumption of moldy food and lack of trace elements also promoted the occurrence of liver cancer [17\u0026ndash;18]. For the clinical treatment plan of this disease, targeted treatment is often given according to the stage and severity of the disease. However, due to the lack of donor liver source, the immature social medical system, and the limited family economic level, the majority of patients choose hepatectomy for treatment [19]. Some studies [20] have pointed out that with the continuous improvement of imaging technology and interventional therapy, the perioperative mortality of hepatectomy is lower than 5%, but the five-year survival rate is still less than 50%. Therefore, how to improve the surgical effect and prognosis of primary liver cancer is a major problem to be solved. As a brand-new concept and technical treatment for liver cancer, precision hepatectomy advocates that minimally invasive surgery should be adopted to reduce the surgical trauma and preserve the normal liver tissue to the maximum extent so as to achieve the optimal surgical effect [21]. In recent years, three-dimensional visualization technology has been gradually applied to patients with liver cancer, but there is no clear conclusion about the clinical efficacy of three-dimensional visualization technology in precise hepatectomy [22]. Therefore, in this study, the use of three-dimensional visualization technology in precise hepatectomy for patients with primary liver cancer can significantly improve the therapeutic effect and safety, and is conducive to improving the prognosis, providing new ideas for the optimization of surgical treatment options for diseases.\u003c/p\u003e\n\u003cp\u003eDuring the occurrence and development of primary liver cancer, not only pathophysiological changes occur in liver tissues, but also high differentiation and distant metastasis of tumor cells may occur. Liver function indicators and serum biochemical indicators play vital roles in the above processes, and changes in relevant levels can sensitively reflect liver function, lesion tissue conditions, etc. Primary liver cancer cells will stimulate the normal liver cell function, resulting in abnormally high and released ALT, AST, and ALB into the blood, decreased TBIL level, and increased liver metabolic burden, etc. [23]. Serum AFP is mainly increased due to continuous damage of liver cells and limited regeneration and differentiation ability, which can sensitively evaluate tumor progression of patients with liver cancer. TSGF is a factor that increases the proliferation and growth of capillaries in and around the tumor during the formation and development of cancer cells, and can effectively judge the early formation and prognosis of tumors. CYFRA21-1 is mostly released into blood as dissolved fragments in normal tissues and cells with relatively low concentration. However, when the body is in a pathological change, it will stimulate the degradation of cytokeratin 19 and activate protease to cause its large release, reflecting the progression of liver cancer. GGT is present in the cytoplasm and epithelial cells of liver cells, and can sensitively identify the degree of differentiation, infiltration and residue of liver cancer cells [24\u0026ndash;25]. Ruzzenente A et al. [26] used high-resolution three-dimensional technology to effectively evaluate liver anatomical features, tumor cells and vascular infiltration, to provide more detailed and targeted parameters for hepatectomy and to improve the accuracy of liver cancer resection. The results of this study showed that the operation time, hepatic blood flow blocking time, intraoperative blood transfusion, intraoperative blood loss, anal exhaust time and hospital stay in the study group were significantly lower than those in the control group. After treatment, the ALT, AST and ALB levels of patients in the two groups were lower than those before treatment, while the TBIL level was higher than those before treatment. The ALT, AST and ALB levels of the study group were significantly lower than those of the control group, while the TBIL level was significantly higher than that of the control group. After treatment, the levels of AFP, TSGF, CYFRA21-1 and GGT in patients of the two groups were lower than those before treatment. The levels of AFP, TSGF, CYFRA21-1 and GGT in the study group were significantly lower than those in the control group. The results were basically similar to those of the Ruzzenente A study, indicating that the use of three-dimensional visualization technology in precise hepatectomy for patients with primary liver cancer could effectively adjust the perioperative parameters, preserve the normal liver tissue as much as possible, and remove the focal tissue. The reason for that analysis may be that three-dimensional visualization technology is use to print and reconstruct the patient\u0026apos;s liver tissue before the precise hepatectomy, the spatial anatomical relationship between tumor cell and normal liver tissue and vascular system are analyzed, the blood vessels on the hepatectomy surface are comprehensively analyze, the resection volume of focal tissue and the residual liver volume are calculated, whether the residual normal liver tissue can maintain postoperative liver compensation is evaluated, and the feasibility of a hepatectomy scheme is analyzed. It helps patients to master the vascular anatomy and tissue dissociation in the surgical resection scheme, shortens the operation time, reduces the operation bleeding and blood transfusion, preserves the normal liver tissue to the maximum extent, and promotes the individualized, minimally invasive and precise development of hepatectomy [27\u0026ndash;28].\u003c/p\u003e\n\u003cp\u003eThe liver is the most functional organ and tissue in the body, with rich blood flow channels and complex vascular system. In the past, surgeons mostly relied on two-dimensional planar images of CT and MRI examinations to assess the surgical plan and imagined three-dimensional images in mind. However, due to the limitation of personal experience, in addition to the abnormalities in the vascular system of some patients and the correlation between tumor blood supply system and the surgical resection surface, the surgical plan often had great risks and uncertainties, and it was prone to massive bleeding during the operation. Complications such as thoracic infection, abdominal infection, and biliary fistula occurred after the operation, and even the recurrence rate and mortality rate were high, affecting the overall prognosis [29]. Fang CH et al. [30] pointed out that three-dimensional visualization technology could accurately determine the anatomical location of primary liver cancer and the morphological characteristics of tumor cells, improve the success rate of accurate hepatectomy and reduce the risk of postoperative complications. The data of this study indicated that the incidence of complications in the study group after treatment was significantly higher than that in the control group. The recurrence rate in the treatment group was significantly lower than that in the control group. The results were basically consistent with those in the Fang CH literature, suggesting that the use of three-dimensional visualization technology in precise hepatectomy could effectively reduce the risk of postoperative complications and recurrence rate of patients with primary liver cancer and improve the treatment safety. Preoperative residual liver tissue and surgical method selection of primary liver cancer are closely related to the postoperative prognosis. In this paper, the functional liver volume, tumor volume and residual liver volume are accurately calculated by three-dimensional visualization technology, in combination with the location of tumor cells and blood supply of patients, to maximize the retention of the residual liver volume, reduce the intraoperative trauma degree, optimize the treatment strategy, and guide the intraoperative meticulous operation, thereby reducing the incidence of complications and improving the prognosis [31].\u003c/p\u003e\n\u003cp\u003eThere are still some shortcomings in this study, which are mainly reflected in the small number of samples, the fact that no grouping analysis was conducted for liver cancer patients with different disease progression, and the fact that there might be some differences between the experimental results and the actual data to a certain extent would reduce the accuracy of the research results. We only explored the pathophysiological state of primary liver cancer, and did not discuss the effects on its psychological state and quality of life. Follow-up time is short. It is worth noting that in clinical practice, the \u0026ldquo;cure rate\u0026rdquo; of liver cancer is typically defined by long-term survival metrics such as the 5‑year overall survival or disease‑free survival rate [32]. Given the relatively short follow-up duration in this study, we did not directly calculate cure rates. Instead, recurrence and mortality rates were used as key intermediate endpoints to assess treatment efficacy and patient outcomes. These indicators are widely recognized as meaningful surrogates for assessing the success of surgical intervention and the likelihood of long‑term cure in oncologic surgery. Therefore, to address these limitations, it is necessary to further expand the sample size of the study, stratified and grouped research according to the different stages of the disease progression of the patients, extend the follow-up time to calculate the long-term survival related indicators such as 5-year overall survival rate, disease-free survival rate and cure rate, and expand the research dimension to include the psychological state and quality of life of the patients into the evaluation system. In addition, it is necessary to enhance the consistency between experimental data and clinical practice, so as to more comprehensively and accurately explore the application value of 3D visualization technology in precise hepatectomy.\u003c/p\u003e\n\u003cp\u003eIn summary, the application of 3D visualization technology in precise hepatectomy for primary liver cancer not only provides surgeons with clearer three-dimensional anatomical guidance, thereby helping to optimize surgical plans and intraoperative procedures, but also effectively shortens the operation time, reduces intraoperative blood loss, while lowering the incidence of postoperative complications and the tumor recurrence rate. Overall, 3D visualization technology is a valuable auxiliary tool in precise hepatectomy for primary liver cancer, and holds positive significance for improving patients\u0026apos; treatment outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Helsinki Declaration and relevant national/institutional ethical standards, with approval from the Ethics Committee of The First People’s Hospital of Jianshan (Approval No. 2025-EC-214). All participants provided informed consent accordingly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to support the findings of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared that they have no conflicts of interest regarding this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLiu Z , Suo C , Mao X ,et al. 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[Efficacy of three-dimensional visualization technology in the precision diagnosis and treatment for primary liver cancer: a retrospective multicenter study of 1 665 cases in China] [J]. Zhonghua Wai Ke Za Zhi. 2020 , 1;58(5):375-382.\u003c/li\u003e\n \u003cli\u003eYang T, Lin S, Xie Q, et al. Impact of 3D printing technology on the comprehension of surgical liver anatomy[J]. Surg Endosc. 2019 ,33(2):411-417.\u003c/li\u003e\n \u003cli\u003eFei, F. R., Hu, R. Y., Gong, W. W., Pan, J., \u0026amp; Wang, M. (2019). Analysis of Mortality and Survival Rate of Liver Cancer in Zhejiang Province in China: A General Population-Based Study. Canadian journal of gastroenterology \u0026amp; hepatology, 2019, 1074286.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"three-dimensional visualization technology, Primary liver cancer, Precise hepatectomy, Liver function, security","lastPublishedDoi":"10.21203/rs.3.rs-9217437/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9217437/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo explore the application value of Three-Dimensional (3D) visualization technology in precise hepatectomy for primary liver cancer.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 70 patients with primary liver cancer admitted to our hospital from May 2019 to May 2022 were selected as research objects, and were randomly divided into control group and study group, with 35 cases in each group. The control group was treated with routine precision hepatectomy, while the study group was treated with precision hepatectomy guided by 3D visualization technology. Liver volume, surgical indexes, liver function indexes, serum biochemical indexes, complications, recurrence rate, and mortality were observed and compared.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e There was no significant difference in the proportion of total liver volume, lesion volume, liver resection volume and residual liver volume between 2 groups (P\u0026gt;0.05). Operation time, hepatic blood flow blocking time, intraoperative blood transfusion volume, intraoperative blood loss, anal exhaust time and hospital stay in the study group were significantly lower than those in the control group (P\u0026lt;0.05). After treatment, ALT, AST and ALB levels in both groups were lower than before treatment, and TBIL levels were higher than before treatment. ALT, AST and ALB levels in the study group were significantly lower than those in the control group, and TBIL levels were significantly higher than those in the control group (P\u0026lt;0.05). After treatment, the levels of AFP, TSGF, CYFRA21-1 and GGT in both groups were lower than before treatment, and the levels of AFP, TSGF, CYFRA21-1 and GGT in the study group were significantly lower than those in the control group (P\u0026lt;0.05). After treatment, the complication rate of the study group was 11.43%, which was significantly higher than that of the control group 37.14% (P\u0026lt;0.05). After treatment, the recurrence rate of the study group was 25.71%, which was significantly lower than that of the control group (40.00%) (P\u0026lt;0.05). The mortality rate of 8.57% was significantly lower than that of control group 22.86 (P \u0026gt; 0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe application of 3D visualization technology in precise hepatectomy for primary liver cancer can effectively remove the lesion tissue, improve liver function and lesion tissue, reduce the incidence of postoperative complications, recurrence rate and mortality, and obtain a better prognosis.\u003c/p\u003e","manuscriptTitle":"Application value of Three-Dimensional (3D) visualization technology in precise hepatectomy of primary liver cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-29 10:17:19","doi":"10.21203/rs.3.rs-9217437/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"30108471414183300847437394972443404422","date":"2026-04-23T01:56:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T12:41:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-27T13:25:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-26T07:34:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-26T07:34:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-03-25T02:56:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"941c26c0-eed5-4db3-b76c-5b0c3bc82d3f","owner":[],"postedDate":"April 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T10:17:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-29 10:17:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9217437","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9217437","identity":"rs-9217437","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}