Analysis Of The Value Of Three-Dimensional Ultrasound Combined With CT Three-Dimensional Reconstruction In The Evaluation Of Recurrent Factors Of Cholecystolithiasis After Cholecystolithotomy

Objective:Three-dimensional ultrasound and CT three-dimensional reconstruction techniques were used to evaluate the relationship between gallbladder fold（GP）,gallbladder angle（GA）and gallbladder contractile function（GCF）after gallbladder-preserving lithotripsy（GPC）,as well as the correlation factors with gallstone recurrence.Methods:In this study,66 patients（male/female:26 patients,average 44.68±13.43 years old）and 21 healthy volunteers without gallstone（male/female:912,mean 38.10±11.86years）were selected from the gallstone center of Shanghai Oriental Hospital from July2021 to July 2022.According to the presence of gallbladder plica,the patients in GPC group were divided into two groups:non-plica gallbladder group（T1）and plica gallbladder group（T2）.There were 35 patients in the unfolded gallbladder group,including 10 males and 25 females,with an average age of 27-68 years,and 31 patients in the folded gallbladder group,16 males and 15 females,with an average age of 28-71years.All the patients in the gallbladder protection and stone extraction group were examined by three-dimensional ultrasound of the gallbladder at 6 and 12 months after operation（simultaneous examination in the normal control group）:after 8 hours and 12hours on an empty stomach,the patients were taken the left lying position and raised with both hands to fully expose the abdomen.First,the two-dimensional image of the gallbladder was obtained.in the two-dimensional image,the longest axis section of the gallbladder was cut to measure the size of the gallbladder,the thickness of the gallbladder wall,the width of the common bile duct and the number of gallbladder folds.T2 group used two-dimensional ultrasound to measure the length of folds and its ratio in the gallbladder fold to the transverse diameter of the gallbladder,and then determine the best display position of the gallbladder image in the three-dimensional acoustic window and scan the three-dimensional image and store it.After the first examination,patients were instructed to eat two fried eggs and a box of 250ml pure milk.Two-dimensional and three-dimensional ultrasound examination was performed again 60minutes after meal.Finally,the gallbladder volume was calculated using three-dimensional volume imaging function.Three-dimensional reconstruction of abdominal CT images of all patients before operation:in the three-dimensional reconstruction images of patients before operation,the maximum longitudinal section of the gallbladder was selected on the sagittal plane,and the line was made from the bottom of the gallbladder to the neck of the gallbladder.The long axis of the human body was used as the reference line,and the clip angle between the line and the long axis was measured,that is,the gallbladder angle（GA）.Medical history（history of acute cholecystitis,family history,course of disease）,total cholesterol 2（TC）,total bile acid（TBA）and total bilirubin（total bilirubin）were performed in all subjects.TBil,triglycerides（TG）,fasting plasma glucose（FPG）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,alanine aminotransferase（ALT）,aspartate transaminase（AST）,body mass index（BMI）and other clinical data were collected.The differences between the normal control group and the gallbladder-preserving stone extraction group were analyzed,and the differences and correlation factors between the non-fold gallbladder group（group T1）and the fold gallbladder group（group T2）in the GPC group were analyzed.Results:（1）the age,BMI and TC in the GPC group were higher than those in the normal control group.HDL-C and FPG in GPC group were lower than those in normal control group,and the difference was statistically significant.（2）the GA of the GPC group was lower than that of the normal control group,and there was significant difference in GA between the two groups.（3）compared with T1 group and T2 group,BMI and TC of T1 group increased, while HDL-C,FPG and GA decreased in T1 group.Compared with the normal control group,BMI and TC in T2 group increased,while age,HDL-C and GA decreased.The age and course of disease in group T1 were higher than those in group T2（P<TI）.（4）in normal control group and GPC group,V_2D of T1 group and T2 group was larger than that of V_3D,and there were significant differences among the three groups.The results of comparison between normal control group and GPC group T1 and T2were as follows:V_3D of T1 group was lower than that of normal control group.Compared with the normal control group,the difference between V_2D and V_3D in T2group increased,while V_3D,GEI1 and GEI2 decreased in T2 group.Compared with T2group,V_3D,GEI1 and GEI2 in TI group increased,while the difference between V_2Dand V_3D decreased in T1 group.（5）data analysis between T1 and T2 in GPC group:the recurrence rate of T1 group was lower than that of T2 group 12 months after cholecystectomy,and there was significant difference between the two groups.Twelve months after gallbladder preservation and stone extraction,the overall gallbladder emptying index in T1 group was higher than that in T2 group.There was significant difference in gallbladder local emptying index between the two groups（P<0.05）.（6）the area under the ROC curve of gallbladder emptying index for predicting recurrent stones in patients undergoing gallbladder sparing lithotripsy was 0.938.The best critical value of gallbladder emptying index is 68.0dyne/cm²,the sensitivity is94.7%,and the specificity is 12.8%.（7）gallbladder emptying index was positively correlated with high density lipoprotein and gallbladder angle（r=0.315,0.787）,but negatively correlated with total cholesterol,number of gallstones,history of acute attack,number of gallbladder folds and length of gallbladder folds（r=0.599,-0.567,-0.635,-0.622,-0.484）.Both of them could be used as independent factors affecting gallbladder emptying index（P<0.05）.Conclusion:In the case of gallbladder folds or gallbladder folding,three-dimensional ultrasound can better measure the changes of gallbladder volume than two-dimensional ultrasound,which provides an intuitive and simple imaging method for clinical evaluation of gallbladder contractile function after gallbladder lithotomy.In addition,CT three-dimensional reconstruction technique was used to analyze the influence of gallbladder angle on gallstone recurrence and other related factors,so as to provide more visual basis for patients with cholecystolithiasis when choosing operation,and it also has good predictive value for gallstone recurrence.