Abstract: Objective:To investigate the clinical value of three-dimensional visualization system combined with choledochofiberscope in the treatment of hepatolithiasis.
Methods:The clinical data of 30 patients with hepatolithiasis who were admitted to the Chenggong Hospital of Xiamen University from January 2012 to January 2013 were retrospectively analyzed. The preoperative two-dimensional images of computed tomography (CT) was converted to the three-dimensional images by IQQA-Liver system. The location of the stones and their relationship with adjacent organs were learned. The surgical plan was made based on the three-dimensional images, and the liver volume and liver volume planed to be excised were measured. Bile duct exploration, washing, lithotripsy and lithotomy were performed using the traditional method combined with choledochofiberscopy. The rate of residual stones and actual volume of liver resected were calculated. The correlation between the volume of actual liver resected and predicted liver resection volume was analyzed by calculating the Pearson correlation coefficient.
Results The three-dimensional reconstruction of the CT data of the 30 patients clearly displayed the size, location of the tumor, as well as its relationship with adjacent blood vessels and bile ducts. Surgical plan was made according the result of three-dimensional reconstruction, including 24 cases of choledochotomy, 15 cases of partial liver resection, and 16 cases of bile duct stricture repairment+cholangioenterostomy. The volume of liver of the 15 patients who were planed to receive partial liver resection was (1 390±148)mL, and the volume of liver planed to be resected was (275±156)mL. Preoperative evaluation of the anatomy of blood vessels, stones and bile ducts based on three-dimensional images was confirmed with operative findings. In actual practice, there were 24 patients received choledochotomy, 6 received liver parenchyma cutting, 15 received partial liver resection and 16 received cholangioenterostomy. The agreement rate of the surgical plan and the actual practice was 100.0%(30/30). The actual volume of liver resected was (261±148)mL. The mean error rate of the volume of liver planed to be resected was 5.4%. The predicted liver resection volume was positively correlated with the actual liver resection volume (r=0.902, P<0.05). Exploration with choledochoscope was routinely performed, including 23 cases 〖HQ〗of lithotomy through choledochofiberscope. The operation time was (121±65)minutes, and the volume of intraoperative blood loss was (158±78)mL. No bile leakage was detected, and the incidence of incisional infection was 3.3%(1/30). The results of CT or choledochoscopy showed that the rate of residual stones after surgery was 10.0%(3/30).
Conclusion:Three-dimensional visualization system combined with choledochofiberscopy is helpful in the treatment of hepatolithisis.