The Study Of Preoperative Imaging Evaluation And Clinical Application Of New Classificationfor Hepatolithiasis

OBJECTIVE: To evaluate the preoperative assessment of hepatobiliary lithiasis by three types of examinations of abdominal B-ultrasonography,enhanced CT and abdominal MRI plus MRCP,and to accurately assess the location of stones,liver atrophy and bile duct stenoses before surgery.A new clinical classification of hepatobiliary lithiasis for more accurate guidance of surgery.METHODS: From January 2007 to May 2017,patients were recruited from Renji Hospital,School of Medicine,Shanghai Jiaotong University for preoperative abdominal B-ultrasonography,upper abdominal enhanced CT or upper abdominal MRI+MRCP examination.The surgery was confirmed in our hospital as liver.Cases of 167 cases of internal duct stones.Analyze the accuracy of the three tests for stone location,liver disease,and biliary stenosis expansion.Further three-dimensional reconstruction of the liver of the three-dimensional model and vascular structure.According to the distal bile duct lesions,hepatic portal lesions and Oddi’s sphincter function,a new type of hepatobiliary lithiasis was proposed to analyze the curative effect of the diagnosis and treatment strategies under the guidance of the new classification.The χ2 test of passing rate was used to compare the differences between the accuracy of various imaging techniques.RESULTS:The diagnostic rate of abdominal B-scan for stones was 74.5%,and the diagnosis rate for hepatic atrophy was 34.7%.The diagnostic rate of enhanced CT for calculus was 86.8%,the diagnostic rate for hepatic atrophy was89.5%,and the diagnostic rate for biliary stricture was 41.1%.The diagnostic rate of MRI+MRCP for calculus was 93.4%,the diagnostic rate for hepatic atrophy was 83.7%,and the diagnostic rate for biliary stricture was 67.7%.The combined use of the three tests resulted in a diagnostic rate of 100% for stones,100% for liver atrophy,and 81.2% for biliary stenosis.The diagnostic rate ofthree-dimensional visualization techniques was 75.0% for the stones,100% for the liver atrophy,and 86.4% for the stenosis.Of the 116 patients undergoing surgery,18(15.5%)were D0P1O0,1(0.9%)were D0P1O1,6(5.2%)were D0P2O0,1(0.9%)were D0P2O1,and 37 were D1P0O0(31.9).%),D1P0O1 type2 cases(1.7%),D1P1O0 type 15 cases(12.9%),D1P2O0 type 32 cases(27.6%),D1P2O1 type 1 case(0.9%),D2P0O0 type 3 cases(2.6%).There was no perioperative death and the perioperative complication rate was 12.1%.Among them,86 cases were followed up with a follow-up rate of 74.1%.The residual stone rate was 20.9%(18/86),the final residual stone rate was 18.6%(16/86),the recurrence rate of stones was 9.6%(8/83),and the incidence of cholangitis was3.6%(3/83).CONCILSION:The combination of three preoperative examinations can improve the accuracy of preoperative evaluation.The three-dimensional reconstruction technology can more intuitively display the morphology of the liver and the spatial structure of the vessels,especially in the judgment of bile duct stenosis has advantages over the enhanced CT.The new classification of hepatobiliary stones has clinical utility.