| Research BackgroundComplicated Hepatolithiasis concept is not yet unified. For bile duct stones, especially for the surgery again hold unequal treatment in terms of experience, understanding of concepts are not consistent. At present, most scholars believe that the complexity of the removal of bile duct stones is the general condition of the patient, because other diseases such as heart, lung, kidney, diabetes, biliary tract surgery constitutes a threat. In general, hepatolithiasis is divided into "complicated hepatolithiasis" types depending on the presence of bilateral hepatolithiasis or the patients, who received one or more biliary tract surgery, have residue or recurrence stones, bile duct stricture requiring reoperations; the patients combine Caroli’S disease or cholangiocarcinoma and the absence of infections, biliary cirrhosis, portal hypertension,septic manifestations, and intrahepatic abscess (Liang Li Jian, Li Shaoqiang complex diagnosis and treatment of bile duct stones principle [J] Chinese Journal of Surgery2009;..29(7):542-544).Complicated hepatolithiasis is the most of difficult to treat, the highest rate of reoperation for benign disease. The basical pathologies are complex bile duct stones and intrahepatic bile duct stricture dilation and mechanical biliary obstruction, biliary tract infections, and liver damage. The pathological nature of the entire process of the evolution of the complex pathology of bile duct stones, there is a close relationship with bile duct stones and bile duct narrow. Report on the clinical display of hepatic cholangiocarcinoma:repeated episodes of biliary tract infections, may be a change in the nature of the lesion. According to the complex evolution of bile duct stones above pathological understanding, Ong et al, raises complex surgical treatment of bile duct stones in principle in1962:"With the detailed understanding of the bile duct pathology, the eradication of stones, narrow and contain foci of disease recurrence hepatic tissue." It’s programs happens to coincide with the ideal," Take out all of the bile ducts stones, remove all of the bile ducts obstructions, remove all of the liver lesions, unobstructed drainaging ", of Wong Chi Keung Academy’s. Because bile duct stones are not only the accumulation of stones, often accompanied occurs in all levels of intrahepatic duct stenosis and hyperplastic lesions, which is the core of treatment, and surgical treatment is still to be one of the most effective means to achieve the therapeutic purposes, which is the most commonly methods. Select surgery programs must be individualized, depending on the number and distribution of intrahepatic bile duct stones, biliary stricture location and extent of the pathological changes in the liver, liver function and general condition of the patient, the development of targeted individualized treatment plan and select appropriate surgical approach.Despite nearly20years of complicated hepatolithiasis understanding and treatment has been significant progress, but because of its complex pathophysiological process and prone to serious complications characteristic, is still plagued by the problem of biliary surgeon. For complicated hepatolithiasis should make adequate preoperative preparation, try to get detailed imaging data and liver function evaluation. Preoperative biliary anatomy, intrahepatic bile duct stones location, distribution, quantity, bile duct stricture location, shape should have an accurate understanding. And pay attention to whether the variation in intrahepatic bile ducts, especially the posterior lobe of the right bile duct variations, the most common is the right hepatic duct abnormalities, especially in the posterior lobe of the right bile duct directly into the left hepatic bile duct. For the right posterior bile duct stones variation due to an acute angle to import alone stone forceps stone or stone surgery choledochoscopic difficult to take the net calculus, which is an important factor in causing postoperative anatomical right posterior residual stones (Mori T, Sugiyama M, Atomi Y. Gallstone disease:Management of intrahepatic stones[J]. Best Pract Res Clin Gastroenterol,2006,20(6):1117-1137.). At the same time, to fully understand the pathology before surgery, surgical causes and methods, as well as the specific circumstances of the current lesion is extremely important in order to formulate a reoperation individualized surgical treatment. Any hasty decision surgery may cause more surgery times, the patients suffer more pain.In recent years, with the development of laparoscopic techniques, endoscopy and interventional techniques, a variety of minimally invasive treatment has been widely reported, such as percutaneous transhepatic biliary lithotripsy and holmium laser mirror or pneumatic lithotripsy of bile duct stones in general has made remarkable efficacy, but for complicated hepatolithiasis postoperative residual stone rate of up to20%-50%(Cheng Y F, Lee T Y, Sheen-Chen S M, et al. Treatment of complicated hepatolithiasis with intrahepatic biliary stricture by ductal dilatation and stenting: long-term results[J]. World J Surg,2000,24(6):712-716.). The above technique for endoscopic treatment of bile duct stones complicated treatment is still controversial, evidence is still lacking the bulk of cases.Currently, the diagnosis of complicated hepatolithiasis mainly rely on B ultrasound, CT and MR and other noninvasive imaging tests to clear stones location, size, number and distribution, location and extent of bile duct stenosis, thereby positioning the diagnosis. Combined liver function in patients, Oddi sphincter function, with or without liver cholangitis episodes, with or without obstructive jaundice, with or without hilar bile duct stricture, portal vein hypertension and splenomegaly combination of factors such as surgical planning. However, due to the widespread distribution of intrahepatic bile duct stones, but with various degrees of bile duct stricture disease and liver damage, these various imaging methods have advantages and disadvantages, and often require the integrated use of several imaging methods, in order to do a more comprehensive diagnosis. There is no ideal diagnostic method to make a comprehensive diagnostic system for stone size, number and distribution, bile duct stenosis and length, pathological liver, bile ducts and blood vessels as well as the relationship. With the development of computer science, based on three-dimensional reconstruction of CT or MRI technology has been widely used in clinical diagnosis and treatment of hepatobiliary surgery activities, its virtual surgical planning system can help hepatobiliary surgeon in advance of surgery simulation operations before surgery, to develop individualized surgery program, thereby reducing the actual surgery pointless damage, improve the actual safety of surgery. At home and abroad there have been several hepatobiliary virtual surgery systems used in clinical, its clinical effect is satisfied and it has great help for clinical work. However, the diagnosis and treatment of intrahepatic bile duct stones used in digital medicine is still in its early stages, less relevant literature. Moreover, for complex three-dimensional reconstruction of bile duct stones bulk of cases (3D technology) system under the guidance of surgical polyclinics evaluate the effect has not been reported in the literature.Based on the above issues, this subject collects the patients treated bile duct stones submillimeter CT complex data quality of the collection from June2008to December2013in Division I of Hepatobiliary of Zhujiang Hospital, Southern Medical University, based on the use of abdominal medical images with independent intellectual property rights3D Visualization System (Medical Image Three-Dimensional Visualization System, MI-3DVS)(software patent number:2008SR18798), built for specific individuals complicated hepatolithiasis complicated treatment procedures3D mode, the system discussed under the technical guidance of surgical polyclinics3D mode bile duct stones in complex clinical value and significance.Part I. Design of three-dimensional reconstruction database system for Complicated HepatolithiasisObjective1. Optimization of CT data acquisition method to obtain high-quality sub-millimeter CT data for complicated hepatolithiasis patients; 2. Interactive volume rendering based segmentation algorithm to construct complicated hepatolithiasis model database;3Clinical trial based on ResMan public management platform to build a complex three-dimensional reconstruction of bile duct stones database system for comprehensive hepatolithiasis patients;4Investigate complex clinical value of the database systemin for the patients with complicated hepatolithiasis.Methods1. Retrospectively collected the complicated hepatolith disease case information of zhujiang hospital, Southern Medical University from June2008to December2013step by step.64rows/256slice CT2. The equipments used to collect data include64rows/256slice CT spiral CT scanner (CT PHILIPS Brilliance, made in Dutch); double tube high pressure syringe and contrast agents (Lopamiro in a dose of370mg I/ml); the self attached Mxview workstation for post processing of the images; HP blade server and high configuration computer (from Clinical Center of Digital Medicine, Southern Medical University, Guangzhou, China) and the abdominal three-dimensional visualization system.3. The procedures for collecting high quality submillimeter CT data of intrahepatic bile duct include:prescanning preparation, plain scanning, trial injection, routine enhanced scanning as well as the transmission and storage of thin layer CT scanning data.(Fang C H, Liu J, Fan Y F, et al. Outcomes of hepatectomy for hepatolithiasis based on3-dimensional reconstruction technique[J]. J Am Coll Surg,2013,217(2):280-288.)4.3D model building method for complex Hepatolithiasis:(1)Interactive volume rendering image segmentation algorithm based on:the first reconstruction volume rendering through the window width and window level adjustment to obtain the desired structure of the biliary clear three-dimensional images.(2)The volume rendering interactive segmentation algorithm as a segmentation plug-in integrated into the abdomen medical image visualization system (MI-3DVS), the import sub-millimeter CT data in DICOM format to MI-3DVS conducted registration, segmentation, three-dimensional reconstruction.(3)Post-processing of the3D model and observe and analyze the three-dimensional structure.By MI-3DVS the surface data processing tools for3D graphics model smoothing and de-noising, then the intrahepatic bile duct system is a combination of3D models and display, zoom in, zoom out, rotate the3D model visualization in space to observe, analyze intrahepatic distribution duct lesions.5. Public use ResMan clinical trial management platform to build complex patientswith bile duct stones dimensional reconstruction of the database system.Results1. The quality of submillimeter CT images obtained via trial injection was optimal, with favorable demonstrations of the biliary lesions, peripheral arterial lesions of the extrahepatic bile duct, peripancreatic lesions and periampullar lesions.2. The3D model of arteries supplying the extrahepatic bile duct can be multidimensionally rotated to clearly demonstrate the origins and distributions of the arteries supplying the extrahepatic bile duct. The arteries supplying the superior segment of extrahepatic bile duct were found to be originated from the right hepatic artery, the gallbladder artery, the left hepatic artery and the proper hepatic artery. However, the arteries supplying the inferior segment of the extrahepatic bile duct were found to be originated from the superioposterior pancreatoduodenal artery, the astroduodenal artery, the gallbladder artery and the retroportal artery.3. The3D model of arteries supplying the extrahepatic bile duct can be multi-dimensionally observed and analyzed for the anatomical relationships. Traditional sketches can only display the anatomic structures on the surface. However, it has the advantage of demonstrating vascular vessels that the3D model fails to display, such as the artery plexus around the bile duct. The sketches are based on the cadaveric perfusion under a surgical microscope.Conclusions:1.64rows/256slice CT spiral CT scanning with optimized data collecting method can obtain high quality submillimeter CT data of the arteries supplying the extrahepatic bile duct, with well demonstrated vasculature. It can facilitate to distinguish the imaging demonstrations of the micro-structures, which satisfies the requirements for segmentation and3D reconstruction of arteries supplying the extrahepatic bile duct.2. Based on volume rendering of interactive segmentation method, the scanning data of arterioles supplying the extrahepatic bile duct can be extracted and segmented for3D reconstruction. The3D model reconstructed by using MI-3DVS can display the three-dimensional anatomical structures of the extrahepatic bile duct and its blood supplying arteries.3. The reconstructed3D model is authentic and direct, which facilitates the learning of anatomic knowledge and related researches.Part II Evaluation of the value in clinical diagnosis and treatment by3D models for Complicated HepatolithiasisPurpose:1. Explore the clinical value on liver lesions using by3D model for complicated hepatolithiasis patients.2. Study the application value of3D models for complicated hepatolithiasis patients with bile duct stones before guiding complex surgical therapy integrated planning, surgical decision-making.3. Study the integrated application value of3D models for complicated hepatolithiasis patients in guiding complex surgical treatment.Method:1.Study subjects:Zhujiang Hospital, Southern Medical complicated by hepatolithiasis ResMan clinical trials of public management platform (Part I) extraction from July2008to December2012in patients with bile duct stones, Southern Medical complex131cases, according to the whether implementation guidance based on complex3D models integrated surgical treatment of bile duct stones, will be divided into A groupgroup (A) and the non-A groupgroup (group B).Case inclusion criteria:(1) More than18years of age;(2) Meet the definition of complicated hepatolithiasis;(3) Liver function classified as Child A or B;(4) Can tolerate surgical treatment.Group A for the purposes of guidance based on3D models integrated surgical treatment of complex bile duct stones, including30males and47females, aged53.1±11.2years, duration of8months-15years; Group B for the purposes of the traditional surgical treatment of complex hepatolithiasis group, including15males and39females, aged54.4±12.7years, duration of7months-14years. Two groups were compared before sex, age, preoperative liver function, disease location, presence or absence of intrahepatic bile duct stricture and liver atrophy and other general information, the difference was not statistically significant (P>0.05), comparable.2. Data acquisition devices are the same as mentioned in first part.3. Submillimeter CT data collection methods are the same as the first part.4. The3D modeling method of complex Hepatolithiasis is same as the first part.5. According to the distribution of intrahepatic stones diagnosis rate, bile duct stenosis and distribution of pathological changes in the liver, comparing the3D model with respect to B-, CT, MRI imaging application advantages in clinical diagnosis.6. Evaluate the effect of patient’s3D models of complex Hepatolithiasis before surgery to guide the planning, surgical decision-making.(1) Import the reconstruction3D models of complex hepatobiliary duct stones in patients into MI-3DVS import system, freely split the model and its components, zoom, rotation, transparency, etc, through comprehensive, multi-angle, multi-level structure observed anatomical characteristics and relationships, specifically:①Range of bile duct stones distribution;②Bile duct stones where the lobe or (and) whether the shrinking segment;③Whether the extrahepatic bile duct stenosis, narrow part;④Have biliary abnormalities;⑤Have biliary cancer;⑥No estimate stones lobe volume. In addition, if the patient with cirrhosis, portal hypertension, obstructive jaundice, liver function should also make a correct evaluation of the compensatory ability. Then use the PHANTOM force-feedback device designed and developed a virtual surgical instruments for various types of simulation model reconstruction surgery, through modeling and simulation comparing multiple surgical procedures to determine the final develop individualized surgical comprehensive treatment program, provided the actual surgery Real-time guidance.(2) The actual surgeryObserve the actual surgery seen in the anatomy and extrahepatic duct stones distribution is consistent with the3D model, and simulation and the actual surgical procedure compliance. Routine using of intraoperative endoscopy diagnose whether residual biliary stones and biliary strictures and conventional T-tube placement for postoperative cholangiography and biliary endoscopy. Routine postoperative cholangiography or biliary endoscopy to confirm whether there is residual stones and biliary stricture.7. The effect evaluation of patient’s3D model of complex bile duct stones in guidance of comprehensive surgical treatment.(1) Perioperative/short-term effect:laboratory data (serum transaminase levels, serum bilirubin, serum albumin, serum hemoglobin levels, white blood cell levels), surgical data (operative time, intraoperative blood loss, intraoperative blood transfusion), stone clearance rate, the rate of surgical complications and perioperative mortality assessed. The potential impact of the factors of postoperative complications: gender, age, preoperative complications, biliary tract surgery, liver resection way cholangioenterostomy, preoperative bilirubin, albumin level, preoperative3D image analysis, using logistic regression models for statistical analysis.(2) Long-term effect:long-term follow-up after bile duct stones and cholangitis recurrence rate is calculated using the Kaplan-Meier method and comparing the difference between the two groups. The using of multivariate Cox regression analysis estimate of possible factors in asymptomatic patients after bile duct stones affect the survival of a complex statistical analysis.8. Statistical analysis:The perioperative/short-term outcomes, including laboratory data (serum aminotransferase level, serum bilirubin level, serum albumin level, serum hemoglobin level, blood leukocytes level), surgical data (operation time, intraoperative blood loss, intraoperative blood transfusion), stone clearance rate, operative morbidity and mortality, were evaluated. Continuous variables were expressed as mean±standard deviation and compared using the Student’s t-test, Chi-squared test, and Fisher’s exact tests. The influence of potential factors that may affect operative morbidity, sex, age, preoperative comorbidities, previous biliary tract surgery, type of hepatectomy (left vs. right), concomitant hepaticojejunostomy, preoperative bilirubin, and albumin levels, preoperative3D images analysis, were analyzed using a logistic regression model. Long-term results, including recurrence of biliary stone and cholangitis rate, were also studied. Long-term survival was computed using the Kaplan-Meier method and compared between groups by the log-rank test. Overall survival was measured from the date of surgery to the time of detection of recurrent stones and cholangitis. Cox regression analysis was used to determine which factors significantly influenced long-term asymptomatic survival. A P-value<0.05was considered statistically significant. All statistical analyses were performed using SPSS13.0(SPSSInc.,Chicago,IL,USA) for Windows.Results:1. The outcome of3D model for complicated hepatolithiasis patients in clinical diagnosis.Using by MI-3DVS software, it can segment accurately and reconstruct the biliary system and stones of complex bile duct stones,3D-assisted surgery group of77patients the liver and its internal piping system and other vivid, three-dimensional sense, can be clearly patients with liver reproduce three-dimensional shape and the presence or absence hypertrophy and atrophy; intrahepatic one, two, three bile duct stenosis or establish a body shape and length and diameter of the bile duct dilatation clear display, part of intrahepatic bile duct stones with extensive intrahepatic bile duct dilation, even four bile duct (sub-hepatic bile ducts) can also be displayed; stone size, number and distribution in the case of the three-dimensional distribution in the liver and other extrahepatic bile duct, portal vein, hepatic vein and hepatic artery and its branches three vessels also clearly visible. The diagnosis rate using by3D model of complex bile duct stones and intrahepatic bile duct stenosis was significantly higher than MRCP, B ultrasonography, CT,(3D vs. CT,81.8%vs.31.3%, P<0.001,3D vs. MRCP,81.8%vs.58.8%, P=0.021). In the diagnosis of liver lesions, the diagnostic performance using by3D model of complex bile duct stones is better than MRCP and B ultrasonography (3D vs. US,98.7%vs.45.4%, P<0.001,3D vs. MRI/MRCP,98.7%vs.82.4%, P=0.018).3D model of intrahepatic bile duct stones the size, quantity and super distribution in extrahepatic bile duct diagnosis rate and MRCP, B ultrasonography, CT was no significant difference.2The effect of3D model for complicated hepatolithiasis patients on operation planning and decision-making during surgery.(1) Use3D models to guide the preoperative planningIn MI-3DVS system, by PHANTOM force feedback device and virtual surgical instruments can be easily reconstructed model for the simulation of various types of surgery, including bile duct exploration lithotripsy, liver resection and so on. Accurate to locate bile duct stones and bile duct stricture by individual segments, preoperative volume measurement can accurately estimate the remnant liver volume after hepatectomy to avoid postoperative liver failure. Visual simulation surgery anatomical relationship observed in liver resection plane important blood vessels and bile duct stones, determine the best individualized surgical plan by optimizing multiple surgical screening programs.3D-assisted surgery group77cases of preoperative planning are:1routine bile duct exploration lithotripsy (including choledocholithotomy surgery, lithotomy intrahepatic bile duct, bile duct stricture plastic surgery, biliary-enteric anastomosis),76cases mainly hepatic resection surgery (including surgical procedures partial hepatectomy, extrahepatic bile duct lithotomy, hepatic bile duct exploration lithotomy section, bile duct stricture plastic surgery, biliary drainage support tube support, bile intestinal anastomosis).(2) The actual surgery1of77patients in A groupgroup underwent bile duct exploration lithotripsy (including choledocholithotomy surgery, lithotomy intrahepatic bile duct, bile duct stricture plastic surgery, biliary-enteric anastomosis),76underwent hepatic resection is lord surgery (including surgical resection of liver section, extrahepatic bile duct lithotomy, hepatic bile duct exploration lithotomy section, bile duct stricture plastic surgery, biliary drainage support tube support, biliary-enteric anastomosis), it is consistent with the preoperative planning in the guidance of3D models.3The effect of3D models for complicated hepatolithiasis patients in guiding surgical treatment.(1) Evaluation of intraoperative surgical treatmentGroup A and Group B in operative time, intraoperative blood transfusion, blood loss and liver blood flow occlusion time statistical comparison results are:(269.7±83.0min vs315.6±81.7min, P=0.002.),(77.9±169.0mL vs.192.6±229.7mL, P=0.002),(411±107.9mL vs.517.2±179.4mL, P=0.015) and (12.7±3.2min vs.17.3±4.0min, P=0.001). Group A1patients with intrahepatic cholangiocarcinoma, the3D model is consistent with the preoperative diagnosis.A set of statistics compared with Group A and Group B in immediate residual stone rate and final residual stone rate results were:(7.8%vs.38.9%, P<0.001), and (5.2%vs.18.5%, P=0.015). A total of25cases of two patients with residual stones occurred, where Group A of six cases,21cases of group B. Two final stone clearance rate was94.8%and81.5%, respectively. Postoperative angiography confirmed by intrahepatic bile duct stricture residual rate was (7.8%vs.35.2%, P<0.001). Postoperative complications between the Group A and Group B a common complication after statistical comparison results:pleural effusion (13%vs.33.3%, P=0.005), wound infection (7.8%vs.20.4%, P=0.035.) and liver dysfunction (2.6%vs.16.7%, P=0.004). Group A and Group B after the comparison of albumin levels (38.7±3.0g/L vs.36.9±4.8g/L, P=0.024). On the impact of postoperative complications (including wound infection, lung infection, pleural effusion, subphrenic infection, liver abscess, biliary fistula, intestinal fistula, upper gastrointestinal bleeding, biliary tract bleeding and hepatorenal syndrome, etc.). Potential risk factors for postoperative complications were logistic regression analysis showed:Screening using forward variable, test level to introduce variable a=0.05, the relevant factors occurred in all11clinical complications related to merger biliary-enteric anastomosis (OR=2.493, P=0.039,95%CI=1.046-5.943) as a potential risk factor for postoperative complications; liver resection (OR=0.629, P=0.016,95%CI=0.431-0.918), preoperative albumin level (OR=0.926, P=0.033,95%CI=0.862-0.994), the3D model before surgery planning (OR=0.260, P=0.002,95%CI=0.112-0.602) after complications potential protective factors occur.(2) Postoperative evaluation of long-term clinical resultsAll patients were followed a median time of28months,3D-assisted surgery group9(11.7%) patients and the surgical group15(27.8%) patients with ultrasound, CT or angiography confirmed intrahepatic bile duct stone recurrence Between the two groups of intrahepatic bile duct stone recurrence rate and cholangitis recurrence rate using Log-rank test, A groupgroup intrahepatic bile duct stone recurrence rate (x2=4.121, P=4.121) and cholangitis recurrence rate (X2=9.866, P=9.866) was significantly lower than the surgery group.Cox risk model related to the use of complex factors affecting postoperative bile duct stones in patients with asymptomatic survival prognosis analysis showed:3D technology for preoperative planning is an effective protective factor complex surgery in asymptomatic patients with bile duct stones survival (RR=0.348,95%CI0.185-0.657,.P=0.001); however, the relevant factors such as gender, age, postoperative complications, preoperative bilirubin, albumin level, the position of intrahepatic stones and other long-term symptom-free survival significant effect None of patients subsequently developed cholangiocarcinoma during follow-up, except one patient in A groupgroup for the cholangiocarcinoma recurrence after surgery.Conclusions1.3D model of complex bile duct stones in patients with a true representation of all contained within the structure of the liver include:bile duct, hepatic artery, hepatic vein, portal venous system and anatomic relationship between the bile duct stones; clear stone size, shape, number, location and traveling bile duct; intrahepatic bile duct stenosis, stenosis, stricture length, reduce ambiguity and thinking on the stability of the surgeon, while avoiding invasive procedures such as ERCP, PTC which may induce the risk of bleeding, pancreatitis, cholangitis.2Through complex hepatobiliary surgery patients before the3D model to guide planning duct stones, develop individualized surgical plan, including removing the greatest degree lobe atrophy, intrahepatic bile duct stones, intrahepatic bile duct stricture, etc., while maximizing protection of postoperative liver lesions function and reduce complications. A groupgroup were residual stone rate, residual rate of intrahepatic bile duct stricture, stone recurrence rate after surgery, postoperative cholangitis recurrence rate, incidence of postoperative complications and postoperative laboratory parameters were superior to conventional surgery group results.3.3D model of complex bile duct stones in patients with intrahepatic bile duct enrich individual lesions traditional imaging diagnostic tools, guidance preoperative planning, reasonable surgical plan to develop the best individualized targeted, avoiding blind exploratory surgery resulting residual stones, bile duct stricture remaining normal liver tissue damage, the risk of intrahepatic vascular system of each injury, as far as possible to shorten the operation time, reduce intraoperative blood loss and intraoperative blood transfusions to patients secondary to combat and prevent postoperative liver function sustained damage.4.3D model of complex bile duct stones comprehensive guide surgical treatment model can effectively reduce postoperative intrahepatic bile duct stones and cholangitis recurrence and improve survival in patients with long-term symptoms, improve the prognosis of patients with complicated bile duct stones.Part III Evaluation of the management complicated hepatolithiasis with operative rigid choledochoscope guided by3D reconstruction technique Purpose:1. Research on3D technology combined with operative rigid choledochoscope comprehensive therapeutic value of complicated hepatolithiasis;2. Comparison of the clinical effect between the3D technology combined with operative rigid choledochoscope comprehensive treatment model and the traditional existing surgical treatment model in the treatment of complicated hepatolithiasis.Method:l.The object of study:complicated hepatolithiasis ResMan clinical trials of public management platform (Part I) extraction by our hospital, Zhujiang Hospital, Southern Medical University from February2012to December2013period by a total of25cases of3D technology combined with intraoperative biliary bile duct stones in patients with complex surgical comprehensive treatment of the rigid choledochoscope which18females,7males, aged31-76years, mean54years, defined as Group C. Meanwhile, during the extraction hospital from June2011to January2012a total of27cases of patients who received conventional surgical treatment of complex data bile duct stones, including22females,5males, aged30-83years, mean53.9years, is defined as the Group D as a control group. More general information on the two groups of patients before sex, age, preoperative liver function, distribution of intrahepatic bile duct stones, previous history of surgery and preoperative biliary cholangitis medical history, the difference was not statistically significant (P>0.05), comparable.2. CT data acquisition equipment used for segmentation, parameters, data, three-dimensional reconstruction of the liver and vascular system, see the second part of the same document.3. Inclusion criteria:Case inclusion criteria:(1) More than18years of age;(2) Meet the definition of complicated hepatolithiasis;(3) Liver function classified as Child A or B;(4) Can tolerate surgical treatment;(5) Agree accept operative rigid choledochoscope treatment. 4. Evaluation:All patients were followed up after treatment with the rigid choledochoscope guided by CT-based3D reconstruction technique and traditional method. The follow-up examinations included T-tube cholangiography, ultrasonography and laboratory tests (hemoglobin, white blood cell count, bilirubin, alanine aminotransferase, aspartate aminotransferase, creatinine, serum urea nitrogen, CEA, CA-199), which were performed every three months. Stones detected in the intrahepatic bile duct within3months after therapies were considered as residual stones. Patients were followed up regularly in the hepatobiliary outpatient clinic. Median follow up time was13months, ranging from5-23months.5. Statistical treatmentContinuous variables were expressed as the mean±standard and compared using Student’s test. Categorical variables were expressed as n (%) and compared using the Chi-square or Fisher’s exact probability test, where appropriate. A P value less than0.05was considered to b... |
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