Abstract: Objective:To investigate the clinical efficacy of threedimensional visualization technique (3DVT) combined with enhanced recovery after surgery (ERAS) in the treatment of hepatolithiasis.
Methods: The retrospective cohort study was conducted. The clinicopathological data of 64 patients with hepatolithiasis who were admitted to Zhujiang Hospital of Southern Medical University from November 2015 to August 2018 were collected. There were 17 males and 47 females, aged from 30 to 82 years, with a median age of 55 years. Of the 64 patients, 23 who completed preoperative assessment and planning using 3DVT, and furthermore received ERAS for perioperative management were divided into 3DVT + ERAS group, and 41 who received preoperative assessment merely under the guidance of 3DVT, combined with conventional perioperative management were divided into 3DVT + conventional group. Observation indicators: (1) preoperative CT and 3DVT assessment; (2) perioperative conditions; (3) follow-up. The follow-up was conducted by outpatient service, email or telephone interview to detect the postoperative recurrence of hepatolithiasis up to March 2019. The measurement data with normal distribution were expressed as Mean±SD, and the t test was used for comparison between groups. The measurement data with skewed distribution were expressed as M (P25, P75), and the Mann-Whitney U test was used for comparison between groups. The count data were expressed as absolute numbers or percentages, and the comparison between groups was performed using the chisquare test or Fisher exact probability.
Results:(1) Preoperative CT and 3DVT assessment: 23 patients in the 3DVT + ERAS group underwent preoperative CT examination and 3DVT assessment, the consistency between CT results and intraoperative findings was 91.3%(21/23), and the consistency between 3DVT results and intraoperative findings was 95.7%(22/23). Fourtyone patients in the 3DVT + conventional group underwent preoperative CT examination and 3DVT assessment, the consistency between CT results and intraoperative findings was 90.2%(37/41), and the consistency between 3DVT results and intraoperative findings was 95.1%(39/41). (2) Perioperative conditions: the volume of intraoperative blood loss, duration of postoperative hospital stay, postoperative total bilirubin, postoperative direct bilirubin, postoperative albumin, postoperative alanine aminotransferase, postoperative aspartate aminotransferase and postoperative hemoglobin were 50 mL (10 mL, 100 mL), 8 days (7 days, 9 days), 12 μmol/L (9 μmol/L, 16 μmol/L), 6 μmol/L (4 μmol/L, 8 μmol/L), (37±4)g/L, 44 U/L (18 U/L, 85 U/L), 32 U/L (20 U/L, 65 U/L), (117±18)g/L in the 3DVT + ERAS group, and 100 mL (50 mL, 300 mL), 13 days (10 days, 16 days), 17 μmol/L (12 μmol/L, 33 μmol/L), 11 μmol/L (7 μmol/L, 21 μmol/L), (29±6)g/L, 78 U/L (43 U/L, 122 U/L), 121 U/L (72 U/L, 176 U/L), (106±13)g/L in the 3DVT + conventional group, respectively; there were significant differences between two groups (Z=-3.084,-4.827,-2.953,-3.632, t=5.261, Z=-2.960,-4.625, t=2.773, P<0.05). Two patients had pulmonary infection and 2 had pleural effusion in the 3DVT + ERAS group, and all the 4 patients were cured after treatment. One case of biliary fistula, 4 cases of pulmonary infection and 5 cases of pleural effusion occurred in the 3DVT + conventional group, and these patients were cured by adequate abdominal drainage, antibiotic therapy and thoracocentesis, respectively. There was no perioperative death in either group. (3) Follow-up: 64 patients were followed up for 6-36 months, with a median time of 23 months. During the follow-up, no recurrent hepatolithiasis in the 3DVT + ERAS group, and 1 case of recurrent hepatolithiasis was confirmed by ultrasound in the 3DVT + conventional group. No cholangiocarcinoma occurred in either group.
Conclusion:The combination of 3DVT and ERAS is effective, safe and feasible in the management of hepatolithiasis, which can accelerate the postoperative recovery of liver function, thus enhancing perioperative recovery and improving the prognosis of patients simultaneously.