Application Value Of Three-dimensional Visualization Technique In Diagnosis And Treatment Of Complex Hepatolithiasis

Objective:To observe the application value of three-dimensional visualization technique in diagnosis and treatment of complicated hepatolithiasis.Methods:1.Research subjects:21 patients(Group A)with complicated hepatolithiasis diagnosed by three-dimensional visualization were treated by hepatectomy in the department of hepatobiliary surgery,first affiliated hospital of the Wannan Medical College from October 2015 to March 2018.At the same time,29 patients with complicated hepatolithiasis(Group B)diagnosed by CT or MRI were treated by traditional hepatectomy.The data of both groups were collected.There were 12 male patients and 9 female patients in Group A,and the average age was in 54.29±10.45.There were 16 male patients and 13 female patients in Group B,and the average age distribution was in 53.52±8.29.There was no statistically significant difference between the two groups in preoperative nutritional status,preoperative liver function,distribution of stones,sex,age,associated hepatic atrophy and intrahepatic bile duct stenosis(p>0.05).2.The methods of collection of original CT data and reconstruction of three-dimensional visualization technology model were introduced in the following text.3.After observing three-dimensional visual reconstruction model of each patient,the hepatic veins were classified according to its walking shape and variation of three branches based on the classification of Couinaud’s Portal Segmentation.The portal vein was also classified according to different origin sites of its intrahepatic branches and the specific shape based on the classification of Couinaud’s portal vein.4.The data of operation results,related laboratory indexes and postoperative complication was collected,and the differences were analyzed between two groups by the statistical software.Results:1.The surgeon were able to observe the adjacent relationship of the liver and liver internal vascular system,biliary tract system and surrounding organ tissues by organ tissues by three-dimensional visualization technique.2.We observed 21 cases of the portal vein system and the hepatic vein system after the nude treatment by three-dimensional visualization technique can be divided into the following types.Type I:The main branch of portal vein in liver is divided into left branch and right branch,and the right branch continues to go to right liver,then the right branch subdivided into right anterior branch and right posterior branch;Type II: The main branch of portal vein in the liver is directly divided into left branch,right anterior branch and right posterior branch;Type III: The right posterior branch is first issued in the main portal vein of the liver and then the right posterior branch is divided into left branch and right anterior branch.It can also be divided into the following types of hepatic veins and branches: Type I: hepatic venous drainage to the inferior vena cava;Type II: Hepatic left vein disappeared;Type III: The left hepatic vein and the middle hepatic vein have common corridor and drainage to the inferior vena cava;Type IV: There are several small branches in the middle hepatic vein.3.The intraoperative blood loss(218.10±42.85ml)in Group A was significantly lower than that in Group B(323.79±40.21ml),p<0.05,which had statistically significant difference.In Group A(195.24±111.70ml),the intraoperative transfusion volume was slightly smaller than that in Group B(237.93±134.73ml)and p>0.05,which indicated that there was no statistically significant difference between the groups.The operation time(246.67±64.45min)of patients in Group A was significantly lower than that in Group B(279.66±60.27min),but p>0.05,which indicated that there was no statistically significant difference between the groups.The postoperative hospitalization days(9.19±1.17d)in Group A were slightly less than that in Group B(10.41±1.55d)and p<0.05,which indicated that there were statistically significant differences between groups.The immediate calculus residue(4.8% vs 27.6%)and the final stone residue rate(0 vs 17.2%)in Group A were lower than Group B,p<0.05,which indicated that there were statistically significant differences between groups.There was no statistical significance in the related laboratory indexes of postoperative patients in the two groups.The recurrence rate of calculi(4.8% vs 24.1%)in Group A was significantly lower than that in Group B,p<0.05,whichindicated that there were statistically significant differences between groups.No deaths were reported in either group.Conclusion:1.The three-dimensional visualization techniquecan accurately show the anatomical variation of the patients ’ portal vein and hepatic veins and their branches,which is helpful to avoid the operation risk and improve the safety of the operation.2.Three-dimensional visualizationtechnique can make the relative position relationship and anatomical relationship between intrahepatic portal vein system,hepatic arteriovenous system,biliaryract system,calculus lesion and liver in three-dimensional form present in the eyes of the operative person.It is advantageous to preoperative planning,the establishment of a strong individualized surgery program,the greatest degree of removal of stones,resection of the presence of biliary stricture and atrophy of the liver tissue,effectively reduce postoperative complications.3.Three-dimensional visualization technology has greatly enriched the patient’s infortmation related operation,to avoid the removal of normal liver tissue and the damage of complicated hepatolithiasis system caused by intraoperative blind detection.This effectively reduces the residual rate of intrahepatic bile duct stones and the residual rate of narrow bile duct.It can also reduce operation time,reduce intraoperative blood loss and so on.