Clinical Application Of 3D Visualization Technique In Precision Liver Resection Of Hepatobiliary Stone Disease

Objective:To explore the value and effect of 3D visualization technique applied in precision hepatic bile duct stone hepatectomy,and to provide an evidence-based basis for 3D visualization technique in clinical hepatectomy patients’surgical decision.Methods:The data of 105 patients with type I（regional）hepatic bile duct stones admitted to the First Affiliated Hospital of Jishou University from January 2019 to January 2021 for laparoscopic precision hepatectomy were retrospectively analyzed,59 patients who were underwent preoperative three-dimensional visual evaluation and surgical design were assigned to the observation group,and 46 patients who were underwent surgical design and evaluation based on CT and/or MRI two-dimensional imaging data were enrolled as control group.Preoperative basic data,inflammatory indexes,main indexes of liver function,intraoperative data,postoperative inflammatory indexes,liver function indexes,postoperative stone review,postoperative complications,postoperative recovery indexes,etc.were collected from both groups,and the data were correlated and analyzed using SPSS26.0 software.Results:（1）There were no statistically significant differences between the preoperative general information,inflammatory indexes,liver function indexes,etc.of the observation group and the control group（P>0.05）.（2）In the observation group,8 patients were corrected preoperatively.During the operation,2 patients were changed the surgical method temporarily of observation group,5 patients were changed the operation method temporarily control group,and there were no statistically significant differences between observation group and control group（P>0.05）.（3）The two groups Complications in the postoperative period were compared.There were statistically significant differences（P<0.05）in bile leakage,bleeding,liver abscess,liver ischemia,peritoneal effusion,and lung infection in the observation group between observation group and control group.There were no statistically significant differences in infection of incisional wound（P>0.05）,pleural effusion,and gastric emptying disorder between observation group and control group.（4）The stone conditions in the postoperative period were compared.There were statistically significant differences（P<0.05）in the immediate residual stone rate,final stone residual rate and intrahepatic bile duct stricture residual rate between observation group and control group.while the recurrence rate of postoperative cholangitis and perioperative mortality rate were not statistically significant（P>0.05）between observation group and control group;（5）There were statistically significant differences in bile leakage,bleeding,liver abscess,liver ischemia,peritoneal effusion,and lung infection between observation group and control group（P<0.05）,There were no statistically significant differences in infection of pleural effusion,and gastric emptying disorder between observation group and control group（P>0.05）.（6）There was no significant difference in liver function indexes between observation group and control group on the first day after operation（P>0.05）,however,the difference was statistically significant on the third and seventh day after surgery（P₁<0.05）;the levels in the observation group were lower than those of control group at 3rd and 7th days after surgery（P>0.05）;there was a time effect between the two groups（P₂<0.05）.There was an interaction effect between group and time（P₃<0.05）,The level of postoperative liver function indexes had a trend of change with time in both groups,and the effect of time factor was different between the two groups;while the postoperative inflammatory indexes showed no statistical significance between the two groups（P>0.05）.（7）Compared with the control group,the difference of drainage tube pulling time in the observation group was statistically significant,while there was no significant difference in postoperative hospital stay and anal exhaust time between observation group and control group（P>0.05）.Conclusion:（1）3D visualization technique applied to precise hepatectomy for hepatobiliary stone disease can develop a reasonable surgical approach and reduce the probability of temporary intraoperative changes in the surgical approach.（2）3D visualization technique applied to precision hepatectomy for hepatobiliary stone disease can reduce postoperative complications.（3）3D visualization technique applied to precision hepatectomy for hepatobiliary stone disease can accurately clean up the lesion,which is valuable in reducing postoperative nibbling residue and narrow bile duct residue.（4）3D visualization technique applied to precision hepatectomy for hepatobiliary stone disease can can shorten the operation time,reduce liver damage,and accelerate postoperative recovery.