Application of intraoperative ultrasound combined with three-dimensional visualization and multimodal image fusion navigation technology in laparoscopic liver cancer resection

doi:10.3877/cma.j.issn.1672-6448.2026.06.004

Abstract

Abstract:

Objective

To evaluate the application effect of intraoperative ultrasound in laparoscopic hepatocellular carcinoma (HCC) resection guided by three-dimensional (3D) visualization and multimodal image fusion navigation technology.

Methods

A retrospective analysis was conducted on 35 patients with complex HCC who underwent laparoscopic hepatectomy between January 2024 and March 2025 at the Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Hebei Medical University. Among them, 15 patients received the combined technology (experimental group), while 20 underwent conventional laparoscopic surgery (control group). Preoperative data, operative time, intraoperative blood loss, number of Pringle maneuvers, postoperative liver function recovery, complications, and short-term recurrence rates were compared between the two groups.

Results

There were no significant differences in preoperative baseline characteristics between the two groups (all P＞0.05). The experimental group had a shorter operative time (P=0.002), fewer Pringle maneuvers (P=0.038), and better postoperative AST (on day 1 and day 3) and ALT (on day 1) levels (all P＜0.05). Postoperative hospital stay and drainage tube duration were also significantly shorter in the experimental group (both P＜0.01). No significant differences were observed in intraoperative blood loss, transfusion rate, complications, or 6-month recurrence rate (all P＞0.05).

Conclusion

Intraoperative ultrasound can further optimize the surgical outcomes of 3D visualization and multimodal image fusion navigation technology in laparoscopic hepatocellular carcinoma resection, reduce surgical trauma, promote postoperative recovery, and demonstrate significant clinical application value.

Key words: Intraoperative ultrasound, Three-dimensional visualization, Multimodal image fusion, Laparoscopic hepatectomy, Hepatocellular carcinoma

Haotian Yu, Chengxu Du, Jingwei Wei, Bin Zhang, Wenfeng Feng, Xinda Yang, Shuai Wang, Yuanbo Bi, Qiusheng Li, Haitao Lyu, Dongrui Li. Application of intraoperative ultrasound combined with three-dimensional visualization and multimodal image fusion navigation technology in laparoscopic liver cancer resection[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2026, 23(06): 458-464.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2026.06.004

https://chaosheng.cma-cmc.com.cn/EN/Y2026/V23/I06/458

Figures/Tables 6

一般资料	试验组（15例）	对照组（20例）	统计值	P值
年龄（岁， $x ¯$ ±s）	53.60±3.27	52.30±3.51	t=1.116	0.272
性别[例（%）]
男	10（66.7）	12（60.0）	0.163	0.686
女	5（22.3）	8（40.0）	0.163	0.686
BMI（kg/m²， $x ¯$ ±s）	20.87±1.69	20.99±1.28	t=-0.237	0.814
ASA分级[例（%）]
Ⅱ级	14（93.3）	17（85.0）	χ²=0.588	0.818
Ⅲ级	1（6.7）	3（15.0）
Child-Pugh分级[例（%）]
A级	13（86.7）	19（95.0）	χ²=0.760	0.794
B级	2（13.3）	1（5.0）
合并基础病[例（%）]
高血压	6（40.0）	4（20.0）	χ²=1.680	0.359
糖尿病	4（26.7）	3（15.0）	χ²=0.729	0.669
冠心病	2（13.3）	3（15.0）	χ²=0.019	1.00
肝炎类型[例（%）]
乙型肝炎	14（93.3）	17（85.0）	χ²=0.588	0.818
丙型肝炎	1（6.7）	3（15.0）
肿瘤部位[例（%）]			χ²=1.663	0.363
Ⅰ段	1（6.7）	0（0.0）
Ⅳa/Ⅴ段	5（33.3）	9（45.0）
Ⅶ/Ⅷ段	9（60.0）	11（55.0）
肿瘤长径[cm，[M（Q₁，Q₃）]	4.0（3.5，5.0）	4.0（4.0，4.7）	Z=-0.532	0.595
AFP [ng/ml，M（Q₁，Q₃）]	122.0（89.0，222.0）	106.5（71.0，177.8）	Z=-0.967	0.333

一般资料	试验组（15例）	对照组（20例）	统计值	P值
年龄（岁， $x ¯$ ±s）	53.60±3.27	52.30±3.51	t=1.116	0.272
性别[例（%）]
男	10（66.7）	12（60.0）	0.163	0.686
女	5（22.3）	8（40.0）	0.163	0.686
BMI（kg/m²， $x ¯$ ±s）	20.87±1.69	20.99±1.28	t=-0.237	0.814
ASA分级[例（%）]
Ⅱ级	14（93.3）	17（85.0）	χ²=0.588	0.818
Ⅲ级	1（6.7）	3（15.0）
Child-Pugh分级[例（%）]
A级	13（86.7）	19（95.0）	χ²=0.760	0.794
B级	2（13.3）	1（5.0）
合并基础病[例（%）]
高血压	6（40.0）	4（20.0）	χ²=1.680	0.359
糖尿病	4（26.7）	3（15.0）	χ²=0.729	0.669
冠心病	2（13.3）	3（15.0）	χ²=0.019	1.00
肝炎类型[例（%）]
乙型肝炎	14（93.3）	17（85.0）	χ²=0.588	0.818
丙型肝炎	1（6.7）	3（15.0）
肿瘤部位[例（%）]			χ²=1.663	0.363
Ⅰ段	1（6.7）	0（0.0）
Ⅳa/Ⅴ段	5（33.3）	9（45.0）
Ⅶ/Ⅷ段	9（60.0）	11（55.0）
肿瘤长径[cm，[M（Q₁，Q₃）]	4.0（3.5，5.0）	4.0（4.0，4.7）	Z=-0.532	0.595
AFP [ng/ml，M（Q₁，Q₃）]	122.0（89.0，222.0）	106.5（71.0，177.8）	Z=-0.967	0.333

患者资料	试验组（15例）	对照组（20例）	统计值	P值
手术时间[min，M（Q₁，Q₃）]	260.0（218.0，310.0）	320.0（292.5，350.0）	Z=-3.076	0.002
出血量[ml，M（Q₁，Q₃）]	120.0（100.0，140.0）	150.0（100.0，177.5）	Z=-0.970	0.332
肝门阻断次数[次，M（Q₁，Q₃）]	7.0（6.0，8.0）	7.5（7.0，9.0）	Z=-2.075	0.038
输血[n（%）]	3（20.0）	3（15.0）	χ²=0.151	1.000

患者资料	试验组（15例）	对照组（20例）	统计值	P值
术后住院时间[d，M（Q₁，Q₃）]	7.0（7.0，8.0）	8.0（7.3，9.0）	Z=-2.945	0.003
拔管时间[d，M（Q₁，Q₃）]	7.0（6.0，7.0）	8.0（7.0，8.0）	Z=2.618	0.009
术后第1天AST [U/L，M（Q₁，Q₃）]	322.0（320.0，367.0）	425.0（345.8，479.0）	Z=-2.485	0.012
术后第3天AST [U/L，M（Q₁，Q₃）]	140.0（120.0，200.0）	200.0（172.5，252.5）	Z=-2.298	0.021
术后第5天AST [U/L，M（Q₁，Q₃）]	88.0（56.0，89.0）	76.0（56.1，85.5）	Z=-0.318	0.751
术后第1天ALT [U/L，M（Q₁，Q₃）]	280.0（244.0，300.0）	320.0（279.3，389.3）	Z=-2.666	0.008
术后第3天ALT [U/L，M（Q₁，Q₃）]	120.0（106.0，170.0）	147.5（117.0，185.3）	Z=-1.285	0.199
术后第5天ALT [U/L，M（Q₁，Q₃）]	77.0（67.0，80.0）	79.0（70.0，87.0）	Z=-0.586	0.558
术后第1天TBil [μmol/L，M（Q₁，Q₃）]	26.0（21.0，30.0）	24.3（22.0，27.8）	Z=-0.050	0.960
术后第3天TBil [μmol/L，M（Q₁，Q₃）]	17.0（12.0，22.0）	12.0（11.0，20.5）	Z=-1.124	0.261
术后第5天TBil [μmol/L，M（Q₁，Q₃）]	10.0（7.0，13.0）	8.5（6.3，14.3）	Z=-0.503	0.615
术后第1天ALB [g/L，M（Q₁，Q₃）]	31.0（29.0，34.0）	31.0（29.6，32.0）	Z=-0.321	0.748
术后第3天ALB [g/L，M（Q₁，Q₃）]	35.0（34.0，36.0）	35.5（35.0，36.0）	Z=-0.924	0.356
术后第5天ALB [g/L，M（Q₁，Q₃）]	36.0（35.0，37.0）	37.0（36.0，38.8）	Z=-1.676	0.094
术后出血[例（%）]	1（6.7）	1（5.0）	χ²=0.044	1.000
术后胆瘘[例（%）]	1（6.7）	4（20.0）	χ²=1.244	0.530
术后肺炎[例（%）]	1（6.7）	2（10.0）	χ²=0.122	1.000
Clavien-Dindo分级[例（%）]			χ²=0.588	0.818
Ⅰ级	14（93.3）	17（85.0）
Ⅱ级	1（6.7）	3（15.0）
术后6个月内肿瘤复发[例（%）]	0（0.0）	2（10.0）	χ²=1.591	0.127

References 18

1	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
2	European Association for the Study of the Liver. EASL Clinical practice guidelines: management of hepatocellular carcinoma[J]. J Hepatol, 2018, 69(1): 182-236.
3	Sun Y, Wu L, Zhong Y, et al. Single-cell landscape of the ecosystem in early-relapse hepatocellular carcinoma[J]. Cell, 2021, 184(2): 404-421. e16.
4	Shindoh J, Kobayashi Y, Umino R, et al. Successful anatomic resection of tumor-bearing portal territory delays long-term stage progression of hepatocellular carcinoma[J]. Ann Surg Oncol, 2021, 28(2): 844-885.
5	Ratti F, Serenari M, Corallino D, et al. Augmented reality improving intraoperative navigation in minimally invasive liver surgery: an interplay between 3D reconstruction and indocyanine green[J]. Updates Surg, 2024, 76(7): 2701-2708.
6	Russolillo N, Borello A, Langella S, et al. Comparison of laparoscopic ultrasound and liver-specific magnetic resonance imaging for staging colorectal liver metastases[J]. Surg endosc, 2021, 35(7): 3547-3553.
7	刘文瑛, 阙园, 欧阳再兴, 等. 末梢门静脉栓塞联合多模态影像技术在巨大肝癌外科治疗中的应用[J]. 实用医学杂志, 2023, 39(12):1546-1550.
8	刘文瑛, 欧阳再兴, 朱剑华, 等. 多模态影像技术在精准肝癌肝切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2022, 11(6): 574-579.
9	Ban D, Tanabe M, Ito H, et al. A novel difficulty scoring system for laparoscopic liver resection[J]. J Hepatobiliary Pancreat Sci, 2014, 21(10): 745-753.
10	陈泰安, 熊永福, 徐建, 等. 复杂肝癌腹腔镜肝切除的应用及挑战[J/OL]. 中华肝脏外科手术学电子杂志, 2022, 11(3): 239-243.
11	方驰华, 田捷, 张鹏, 等. 数字医学技术在肝胆胰外科的应用: 20年历史回顾与未来展望[J]. 中华外科杂志, 2021, 59(10): 807-811.
12	Lang H, Huber T. Virtual and augmented reality in liver surgery[J]. Ann Surg, 2020, 271(1): e8.
13	蔡伟, 向飞, 黄耀欢, 等. 三维可视化技术在巨块型肝癌可切除性评估及手术规划中的应用价值[J]. 中华消化外科杂志, 2017, 16(1): 53-58.
14	Fang C, Zhang P, Qi X. Digital and intelligent liver surgery in the new era: Prospects and dilemmas[J]. EBioMedicine, 2019, 41: 693-701.
15	Zeng X, Li X, Lin W, et al. Efficacy of laparoscopic parenchyma-sparing hepatectomy using augmented reality navigation combined with fluorescence imaging for colorectal liver metastases: a retrospective cohort study using inverse probability treatment weighting analysis[J]. Int J Surg, 2025, 111(2): 1749-1759.
16	陶海粟, 王壮雄, 黎柏宏, 等. 增强现实导航联合吲哚菁绿荧光影像技术在精准引导腹腔镜解剖性肝脏8段切除中的应用研究[J]. 中华外科杂志, 2023, 61(10): 880-886.
17	Wang P, Wang S, Luo P. Evaluation of the effectiveness of preoperative 3D reconstruction combined with intraoperative augmented reality fluorescence guidance system in laparoscopic liver surgery: a retrospective cohort study[J]. BMC Surg, 2025, 25(1): 288.
18	Fujiyama Y, Wakabayashi T, Mishima K, et al. Latest Findings on Minimally Invasive Anatomical Liver Resection[J]. Cancers (Basel), 2023, 15(8): 2218.

[1]	Yilun Cai, Yan Chen, Jinling Dong. Diagnostic value of human Runt-related transcription factor 3, E-cadherin, and Ras association domain family 1A gene methylation in hepatitis C virus-associated hepatocellular carcinoma [J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2026, 20(02): 106-113.
[2]	Hao Li, Baojin Li, Weifeng Chen. Analysis of risk factors for infectious complications following open hepatectomy in patients with hepatocellular carcinoma [J]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(03): 157-160.
[3]	Rong Liu. Robot-assisted right hemihepatectomy [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(04): 324-324.
[4]	Jian Li, Wei Zhang, Shaojie Zeng, Dean Mu. A comparative study on the clinical efficacy of percutaneous ablation and laparoscopic hepatectomy for early intrahepatic cholangiocarcinoma [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(02): 187-190.
[5]	Yongshun Li, Fanfan Li, Juan Chang, Xiaochun Yang. Advances in puncture localization techniques for percutaneous nephrolithotomy [J]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(05): 594-600.
[6]	Yican Zhu, Jun Hu, Binghua Li, Decai Yu. Study on the efficacy and prognosis of robotic surgery versus laparoscopic surgery for hepatocellular carcinoma based on propensity score matching [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2026, 19(04): 225-232.
[7]	Jia Luo, Jiang Han, Yihe Dai, Yun Jin. Application of ultrasound-guided microwave ablation in single-incision laparoscopic surgery for liver tumors [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(05): 724-730.
[8]	Xiaoge Dong, Haining Fan, Lichao Hou, Kaihao Du, Haigang Liu, Zhanjin Wang, Weiwei Xue, Yachao Shi, Liumu Wei, Zhan Wang. Application of three-dimensional visualization technology, ICG fluorescence tracing and intraoperative real-time ultrasound in individualized precise diagnosis and treatment of liver cancer [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(02): 181-189.
[9]	Ling Zhang, Huilin Chen, Ningyang Jia. Interpretation of expert consensus on clinical application of vessels encapsulating tumor clusters in the diagnosis and treatment of hepatocellular carcinoma (2026 edition) [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(04): 289-293.
[10]	Hongtao Zhang, Dazhong Yu, Jingyi Wang. Evaluation of the clinical value of microvascular invasion in hepatocellular carcinoma based on the regression model combining microvascular imaging and contrast-enhanced ultrasound [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(03): 248-255.
[11]	Chinese Society of Research-oriented Hospitals Radiology Professional Committee, Shanghai Anti-Cancer Association Specialized Committee for Focus Diagnosis and Treatment of Solid Tumors. Expert consensus on the clinical application of vessels encapsulating tumor clusters in the imaging diagnosis and treatment of hepatocellular carcinoma (2026 edition) [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(03): 193-198.
[12]	Xiaokun Chen, Shunda Du. Advances and challenges of radiomics in hepatocellular carcinoma [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(02): 97-100.
[13]	Zengxia Gao, Yunfei He, Na Zhao. Evaluation value of texture features of DCE-MRI combined with Gd-EOB-DTPA MRI for the therapeutic response after transcatheter arterial chemoembolization in hepatocellular carcinoma [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(02): 108-113.
[14]	Tingxi Huang, Liujing Zhang, Wenle Tan, Qi Zhu, Feng Duan. Transcatheter Interventional Therapy Combined with Targeted Immunotherapy versus Targeted Immunotherapy Alone in Patients with Unresectable Hepatocellular Carcinoma: A Meta-analysis [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(03): 221-234.
[15]	Kun Liu, Li Li, Lu Huang, Mingzheng Hu. The Efficacy of Transcatheter Arterial Chemoembolization Combined with Hepatic Arterial Infusion Chemotherapy in the Treatment of Unresectable Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(03): 235-242.

Please choose a citation manager

Content to export