Application Of Three-dimensional Visualization Combined With Percutaneous Transhepatic Bile Duct Puncture In The Treatment Of Intra-and Extra-hepatic Bile Duct Stones

Part 1 Research on Biliary Tract Anatomy and Variation Based on Three-dimensional Reconstruction of Biliary TractObjective1.The Hisense computer-assisted surgery system(CAS)was used to reconstruct the three-dimensional model of the biliary tract of 50 Chinese people,and to study the anatomy and variation of the biliary system based on the three-dimensional model.2.To explore whether the IL-9 antibody can alleviate imiquimod-induced psoriasis lesions in mice.3.To explore the clinical significance of anatomical variation of the biliary tractMethodsSelected from January 1,2019 to December 31,2020,due to various reasons(including stones,tumors,inflammation,etc.)caused biliary obstruction,in the Second People’s Hospital of Guangdong Province,256 rows of upper abdominal spiral CT scan+There were 50 patients undergoing enhanced scanning,and all selected patients were approved by the Ethics Committee of Southern Medical University and signed an informed consent form.The Hisense computer-assisted surgery system was used to reconstruct the three-dimensional CT data of the abdomen of these 50 Chinese patients with obstructive biliary tract disease to obtain a three-dimensional model of the Chinese biliary tract,observe and analyze the shape of the intrahepatic biliary system,according to the right posterior lobe The bile ducts(RPSD),right anterior bile ducts(RASD)and left hepatic ducts(LHD)join the way and whether there are accessory hepatic ducts to classify the bile ducts.ResultsSuccessfully reconstructed 50 three-dimensional models of the bile ducts of Chinese people.The bile ducts above the second level were reconstructed completely and the structure was clear.Refer to the Huang classification system to classify the three-dimensional model of the bile duct according to the confluence of the right posterior bile duct,right anterior bile duct,and left hepatic duct.It can be divided into 7 types.Twenty-seven cases have typical anatomical structures of the bile duct.The right posterior bile duct and the right anterior bile duct merge to form the right hepatic duct,which together form the common hepatic duct with the left hepatic duct,accounting for 54%;5 cases have a so-called "triple confluence" variant,with the right posterior bile duct and the right anterior bile duct.It merged with the left hepatic duct into the common hepatic duct,accounting for 10%;7 cases were "cross-type"variants,the right posterior hepatic duct was abnormally drained to the left hepatic duct,accounting for 14%;7 cases were the right posterior lobe bile duct draining to the common hepatic duct,Accounted for 10%;1 case had the right posterior lobe bile duct drained to the cystic duct,accounting for 2%;1 case had no left main hepatic duct,that is,the fourth bile duct of the draining liver and the second and third bile ducts of the draining liver were inserted into the common hepatic duct,accounting for 2%;4 cases had accessory hepatic ducts,of which 3 cases coexisted with other mutations.Conclusion Based on the characteristics of obstructive biliary tract disease on the 256-slice spiral CT image data,the CAS system can be used to reconstruct a clear and three-dimensional biliary tract three-dimensional model,which can accurately display the anatomy of the biliary system and identify the variation of the biliary tract,which has certain clinical significance.Part 2 Application of three-dimensional visualization of biliary tract combined with percutaneous transhepatic bile duct puncture in the treatment of intrahepatic and extrahepatic calculiObjectiveUse Hisense Computer-Assisted Surgery System(CAS)to reconstruct the three-dimensional model of the liver and gallbladder and puncture needles of patients with biliary calculi,formulate the most reasonable puncture approach and puncture angle,and evaluate the percutaneous hepatic stage I biliary fistula under ultrasound guidance(PTOBF)combined with choledochoscope lithotripsy and its application value.MethodsA total of 46 patients with intrahepatic and extrahepatic bile duct stones who were admitted to the Second People’s Hospital of Guangdong Province from January 1,2019 to December 31,2020 were included in this study.All patients underwent percutaneous hepatic stage 1 biliary fistula under the guidance of B-ultrasound(PTOBF)combined choledochoscope lithotripsy and lithotripsy.Among them,21 patients used the CAS system to perform three-dimensional reconstruction of the liver and gallbladder before the operation,and performed the preoperative simulated puncture.The reasonable puncture approach and puncture angle were formulated and set to A group.There are 25 cases without three-dimensional reconstruction before the operation and directly underwent PTOBF surgical treatment,which is set as group B.The operation time,puncture times,puncture success rate,intraoperative blood loss,postoperative stone residual rate,and postoperative hospital stay were compared between the two groups.ResultsCompared with group B,group A has shorter operation time,higher puncture success rate,less puncture times,less intraoperative blood loss,and lower residual rate of postoperative stones.ConclusionIn the treatment of intrahepatic and extrahepatic bile duct stones by percutaneous hepatobiliary ostomy and choledochoscopy lithotripsy,the use of CAS system for simulated puncture can improve the efficiency of stone removal and the safety of operation,which has high application value.