OBJECTIVETo assess the value of three-dimensional (3D) visualization technique in preoperative diagnosis, preoperative evaluation and surgical guidance for hepatolithiasis.

METHODSThe 64-slice spiral CT data of 30 hepatolithiasis cases were imported in a self-designed medical image processing system for 3D reconstruction of the intrahepatic bile duct. The preoperative diagnosis and pathological classification were derived from the reconstructed model, with which the feasibility and safety of the surgical plan were assessed by simulation of the surgical procedures. The consistency between the simulated procedure and the actual operation was evaluated, and the residual stones were detected using cholangiography with a T-shaped tube.

RESULTSWhen the model setting was configured to render the liver translucent, the system clearly displayed the site and number of the bile duct calculi as well as the expansion or narrowing of the intrahepatic bile duct. A total consistency (100%) was found between the surgical findings and the preoperative findings based on the 3D model, and also between the actual surgical procedures and the preoperative simulation in 30 cases. The consistency rate between the actual surgical protocols and the preoperative surgical plan was 90%. Follow-up of 27 of the patients for 6 months showed a recurrence rate of 7.4% (2/27) after the operation.

CONCLUSIONThe 3D visualization system allows accurate preoperative diagnosis and precise surgical operation to reduce the postoperative recurrence rate, and can be of value as a new diagnostic and treatment modality in biliary surgery.