Clinical study of three-dimensional reconstruction combined with intraoperative ultrasound precise hepatectomy in complicated intrahepatic bile duct stones
10.3760/cma.j.cn113884-20230814-00035
- VernacularTitle:三维重建联合术中超声腹腔镜精准肝切除在肝内胆管结石中的应用
- Author:
Guowei LI
1
;
Nianyong YUAN
;
Jianfeng CAI
;
Wei DING
;
Qunfeng XIA
;
Weiming YU
Author Information
1. 杭州市富阳区第一人民医院肝胆胰外科，杭州 311400
- Keywords:
Hepatectomy;
Intrahepatic bile duct stones;
3D reconstruction;
Laparoscopic ultrasound;
Liver function
- From:
Chinese Journal of Hepatobiliary Surgery
2023;29(12):881-886
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy of preoperative three-dimensional (3D) image reconstruction combined with intraoperative dynamic ultrasonography (IOUS) in laparoscopic precision hepatectomy for intrahepatic bile duct stones.Methods:The clinical data of 66 patients with intrahepatic bile duct stones undergoing laparoscopic hepatectomy in the First People's Hospital of Fuyang District, Hangzhou from January 2018 to January 2023 were retrospectively analyzed, including 32 males and 34 females, aged (49.6±15.2) years old. Patients were divided into the study group ( n=32), who underwent laparoscopic precision hepatectomy using 3D reconstruction combined with IOUS, and the control group ( n=34), who underwent conventional laparoscopic hepatectomy. Perioperative data including the operation time, intraopera-tive blood loss, total volume of drainage on postoperative day (POD) 3, and the rates of complications were compared between the groups. Serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), liver function indices including total bilirubin (TBil) and alanine aminotransferase (ALT) were monitored preoperatively and on POD 1, 3, 5, and 7. Results:The operation time was shorter in the study group [(178±17) min vs. (189±18) min, t=2.55, P=0.010]. The intraoperative blood loss was reduced in the study group [(218±19) ml vs. (395±21) ml, P<0.001]. The incidence of total volume of drainage >300 ml on POD 3 were comparable between the groups [9.4%(3/32) vs. 14.7%(5/34), P=0.507]. There were no significant differences in preoperative serum level of TBil, ALT, CRP and IL-6 between the groups (all P>0.05). Compared to the control group, serum levels of TBil, ALT and CRP in the study group were decreased on POD 1, 3, 5 and 7, and IL-6 was decreased on POD 1 and 3 (all P<0.05). The occurrences of postoperative bile leakage [9.4% (3/32) vs. 29.4% (10/34)] and liver cutting surface fluid accumulation [12.5% (4/32) vs. 35.3% (12/34)] and the rate of stone retention [3.0% (1/32) vs. 20.6% (7/34)] were lower in the study group (all P<0.05). Conclusion:Preoperative 3D image reconstruction combined with IOUS in laparoscopic precision hepatectomy for intrahepatic bile duct stones could reduce intra-operative blood loss, hepatic inflammatory response, and postoperative complications.
