Objective To evaluate the clinical value of percutaneous transhepaticcholangioscopic lithotomy (PTCSL)combined with rigid cholangioscopy in treatment of recurrent hepatolithiasis. Methods Retrospective analysisof therapeutic result of 54 patientswith postoperative recurrent hepatolithiasisduring January 2012 to January 2015. Twenty eight cases were recruited as the observation group (PTCSL group). Twenty six cases were recruited as the control group (Laparotomy group). Following parameters were observed, operation time, intraoperative blood loss, clearance of stones and postoperative hospital stay. Results The operation time, intraoperative blood loss , clearanceof stones , and the postoperative hospital stay of the PTCSL group werebetter than that of the laparotomy group (P<0.05). The number of patients with postoperative pain of the PTCSL group was significantly lower than in the laparotomygroup (P<0.05). There were no significant differences in other complication rates. There was no difference in terms of stone recurrence , incidence of cholangitis and intrahepatic biliary strictures recurrence ratebetween two groups in follow-up period. Conclusions PTCSL combined with rigid choledochoscopywas a safe and effectivemethod with minimal invasion formanagement of the postoperative recurrent hepatolithiasis. It could got a better resultsin the short-term outcomes.

Objective To explore the clinical value of laparoscopy combined with choledochoscopy in repeat surgery for hepatolithiasis. Methods The clinical data on 86 patients who had undergone repeat surgery for hepatolithiasis during January 2010 to December 2015 were retrospectively analyzed. 36 patients received laparoscopy combined with choledochoscopy(laparoscopy group),while 50 patients received laparotomy(laparotomy group). Surgical duration,intraoperative blood loss,intraoperative transfusion,stone clearance rates,length of postopera-tive hospital stay,and rate of complications were observed and analyzed. Results There were no significant differ-ences in surgical duration,intraoperative blood loss,intraoperative transfusion,stone clearance rates,and rate of complications between the two groups(P>0.05). Length of postoperative hospital stay was significantly shorter in the laparoscopy group than in the laparotomy group(P < 0.05). There was no significant difference in recurrence rates of stone and cholangitis within the follow-up period(P>0.05). Conclusions Use of laparoscopy combined with choledochoscopy in repeat surgery for hepatolithiasis is safe and feasible and has a satisfactory efficacy.

Objective To explore the effect of LPLD (laparoscopic peritoneal lavage and drainage ) on SAP (severe acute pancreatitis), and to compare its effect with that of non- LPLD (conservative medical management). Methods We collected data from 87 consecutive patients with SAP, from January 2009 to May 2014, including LPLD group (n = 46) and non-LPLD group (n = 41). LPLD was performed in the 1st and 2nd week after the disease onset in LPDP group and other treatment in LPDP group was the same as that in non-LPLD group. Data were comparatively analyzed in two groups about the length of hospital stay, ICU stay, cure rate, incidence of complications and in-hospital mortality. Results In LPLD group, hospital stay, and ICU stay were shorter while cure rate was higher than those in non-LPLD group , and the difference was statistically significant (P < 0.05). In terms of the incidence of complications in two groups, only the incidence of sepsis indicated statistical significance (P < 0.05) and in-hospital mortality did not differ significantly between two groups (P > 0.05). Conclusion Compared with non-LPLD, LPLD is effective in short outcome, which is a promising treatment for SAP.

Objective To compare the clinical treatment effects, advantages and disadvantages,and clinical application value of percutaneous liver mirror of gravel (PTCSL) treating hepatolith in two different paths, and provide the reference for the future operations. Methods 81 patients with liver and gallbladder stones form March 2007 to July 2007 were selected, and they were randomly divided into observation group and control group. Observation group take colostomy lithotomy method, which is the one step colostomy lithotomy method, while the control group take two-step methods. Then stone-taking net rate, incidence of complications and hospitalization time were compared between two groups of patients after the treatment cycle of the bleeding. Results After the treatment, statistical results showed that calculi net rate, incidence of complications and length of hospital stay in two groups of patients were not significantly differences (P > 0.05). But the blood loss by the method of one-step colostomy lithotomy in observation group was obviously lower than by the two-step method in control group (P<0.05). Conclusions In clinical, percutaneous liver way mirror lithotripsy (PTCSL) is a more effective method for treatment of hepatolith, two kinds of surgical methods on the path in the clinical treatment effect and complications of the control aspect have the obvious curative effect, but the one-step method of colostomy lithotomy has less blood loss, which under certain conditions can be considered as the choice of operation.

OBJECTIVETo study the value of three-dimensional (3D) visualization, 3D printing and 3D laparoscopy (3-3D techniques) in the diagnosis and surgical treatment of hepatic tumors.

METHODSFrom November 2013 to January 2015, 22 patients with hepatic tumors admitted in our department underwent abdominal thin-slice CT scanning. The CT images were imported into Medical Image three Dimensional Visualization System (MI-3DVS) for 3D reconstruction. Standard Template Library (STL) files were exported for 3D printing. The hepatic vascular classification and predicted liver resection were performed with the aid of MI-3DVS system. The 3D models were then printed and virtual liver resections were executed accordingly. Based on these preoperative surgical planning data, we performed anatomical hepatectomy using 3D laparoscopy, and the intraoperative blood loss, volume of virtual and actual liver resection and postoperative hospital stay were recorded.

RESULTSAccording to Michels's classifications, 19 patients had type I, 2 had type II, and 1 had type VIII hepatic arteries; based on Cheng classifications, the portal vein was classified into type I in 17 cases, type II in 2 cases, and type III in 2 cases, and type IV in 1 case; according to Nakamura classifications, the right hemiliver hepatic vein was classified into type I in 10 cases, type II in 7 cases, and type III in 5 cases. In the virtual operations, the mean volume of liver resected was 490 ± 228 ml and the mean remnant liver volume was 885 ± 139 ml, with a remnant to functional liver volume ratio of (71 ± 11)%. The 3D printed models stereoscopically displayed the location of the liver tumors and adjacent liver vascular structure clearly. Laparoscopic hepatectomy was performed successfully in 20 patients guided by the 3-3D techniques, and the other 2 patients required convertion to open hepatectomy. The mean operation time was 186 ± 92 min, the intraoperative blood loss was 284 ± 286 ml, the mean actual liver resection volume was 491 ± 192 ml, and the mean postoperative hospital stay of the patients was 8.6 ± 3.7 days.

CONCLUSIONSThe 3-3D technique can facilitate the evaluation of preoperative risk and critical anatomical structures and navigate the surgical procedure in real time in anatomical hepatectomy for hepatic tumors.

Blood Loss, Surgical ; Hepatectomy ; Hepatic Artery ; anatomy & histology ; Hepatic Veins ; anatomy & histology ; Humans ; Imaging, Three-Dimensional ; Laparoscopy ; Liver Neoplasms ; diagnosis ; surgery ; Portal Vein ; Printing, Three-Dimensional ; Tomography, X-Ray Computed

Objective To study the value of three-dimensional (3D) visualization, 3D printing and 3D laparoscopy (3-3D techniques) in the diagnosis and surgical treatment of hepatic tumors. Methods From November 2013 to January 2015, 22 patients with hepatic tumors admitted in our department underwent abdominal thin-slice CT scanning. The CT images were imported into Medical Image three Dimensional Visualization System (MI-3DVS) for 3D reconstruction. Standard Template Library (STL) files were exported for 3D printing. The hepatic vascular classification and predicted liver resection were performed with the aid of MI-3DVS system. The 3D models were then printed and virtual liver resections were executed accordingly. Based on these preoperative surgical planning data, we performed anatomical hepatectomy using 3D laparoscopy, and the intraoperative blood loss, volume of virtual and actual liver resection and postoperative hospital stay were recorded. Results According to Michels's classifications, 19 patients had type I, 2 had type II, and 1 had type VIII hepatic arteries;based on Cheng classifications, the portal vein was classified into type I in 17 cases, type II in 2 cases, and type III in 2 cases, and type IV in 1 case;according to Nakamura classifications, the right hemiliver hepatic vein was classified into type I in 10 cases, type II in 7 cases, and type III in 5 cases. In the virtual operations, the mean volume of liver resected was 490±228 ml and the mean remnant liver volume was 885 ± 139 ml, with a remnant to functional liver volume ratio of (71 ± 11)%. The 3D printed models stereoscopically displayed the location of the liver tumors and adjacent liver vascular structure clearly. Laparoscopic hepatectomy was performed successfully in 20 patients guided by the 3-3D techniques, and the other 2 patients required convertion to open hepatectomy. The mean operation time was 186±92 min, the intraoperative blood loss was 284±286 ml, the mean actual liver resection volume was 491±192 ml, and the mean postoperative hospital stay of the patients was 8.6±3.7 days. Conclusions The 3-3D technique can facilitate the evaluation of preoperative risk and critical anatomical structures and navigate the surgical procedure in real time in anatomical hepatectomy for hepatic tumors.

Objective To study the value of three-dimensional (3D) visualization, 3D printing and 3D laparoscopy (3-3D techniques) in the diagnosis and surgical treatment of hepatic tumors. Methods From November 2013 to January 2015, 22 patients with hepatic tumors admitted in our department underwent abdominal thin-slice CT scanning. The CT images were imported into Medical Image three Dimensional Visualization System (MI-3DVS) for 3D reconstruction. Standard Template Library (STL) files were exported for 3D printing. The hepatic vascular classification and predicted liver resection were performed with the aid of MI-3DVS system. The 3D models were then printed and virtual liver resections were executed accordingly. Based on these preoperative surgical planning data, we performed anatomical hepatectomy using 3D laparoscopy, and the intraoperative blood loss, volume of virtual and actual liver resection and postoperative hospital stay were recorded. Results According to Michels's classifications, 19 patients had type I, 2 had type II, and 1 had type VIII hepatic arteries;based on Cheng classifications, the portal vein was classified into type I in 17 cases, type II in 2 cases, and type III in 2 cases, and type IV in 1 case;according to Nakamura classifications, the right hemiliver hepatic vein was classified into type I in 10 cases, type II in 7 cases, and type III in 5 cases. In the virtual operations, the mean volume of liver resected was 490±228 ml and the mean remnant liver volume was 885 ± 139 ml, with a remnant to functional liver volume ratio of (71 ± 11)%. The 3D printed models stereoscopically displayed the location of the liver tumors and adjacent liver vascular structure clearly. Laparoscopic hepatectomy was performed successfully in 20 patients guided by the 3-3D techniques, and the other 2 patients required convertion to open hepatectomy. The mean operation time was 186±92 min, the intraoperative blood loss was 284±286 ml, the mean actual liver resection volume was 491±192 ml, and the mean postoperative hospital stay of the patients was 8.6±3.7 days. Conclusions The 3-3D technique can facilitate the evaluation of preoperative risk and critical anatomical structures and navigate the surgical procedure in real time in anatomical hepatectomy for hepatic tumors.

ObjectiveTo investigate the application value of three-dimensional visualization system (MI-3DVS software system) in the preoperative evaluation and surgical planning for hilar cholangiocarcinoma.MethodsThirteen patients with hilar cholangiocarcinoma undergoing preoperative evaluation with MI-3DVS software in Zhujiang Hospital, Southern Medical University between June 2009 and December 2013 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 13 patients, 8 were males and 5 werefemales with the age ranging from 34 to 81 years old and the median of 55 years old. Enhanced scan of liver, gallbladder, pancreas, spleen and blood vessels in abdominal cavity was performed on the patients with 64-slice or 256-slice spiral CT. Four sets of medical digital imaging and data of plain scan phase, arterial phase, portal venous phase and venous phase were collected. The data of each phase were introduced into MI-3DVS to perform image segmentation and three-dimensional reconstruction. The three-dimensional relationship between tumor and intrahepatic bile duct, hepatic artery, portal venous system and hepatic venous system was observed after the reconstructed images were visualized and Bismuth-Corlette classiifcation was determined for the tumors. Moreover, surgery was simulated and surgical planning was formulated.Results The reconstructed models of 13 patients all exactly displayed the shape of liver and anatomic landmark of duct system. The structure and shape of hilar cholangiocarcinoma and various intrahepatic duct systems were realistic and stereoscopic and the direction of various branches was clear. Bismuth-Corlette classification of tumors was determined according to the results of three-dimensional reconstruction. One case was typeⅢa, 7 were typeⅢb and 5 were typeⅣ. The accuracy rate of tumor classification was 100%(13/13) by preoperative three-dimensional reconstruction. The coincidence rate of simulated surgery and actual operative procedure was 85% (11/13). The median operation time was 630 (300~720) min and the intraoperative blood loss was 410 (110~1 800) ml. The incidence of surgical complications was 23% (3/13). Two patients developed incision infection and 1 developed bile leakage. All were cured with conservative treatment. ConclusionThree-dimensional visualization system may accurately, directly and dynamically display the hilar cholangiocarcinoma and its three-dimensional adjacent relation, which may be used to perform accurate preoperative evaluation and surgical planning for patients.

ObjectiveTo investigate the construction and clinical application of three-dimensional visualization platform in diagnosis and treatment of primary liver cancer.MethodsFifty-six patients with liver cancer diagnosed and treated in Zhujiang Hospital of Southern Medical University between January 2012 and December 2014 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 56 patients, 49 were males and 7 were females with the average age of (47±7) years old. The 256-slice spiral CT scan was performed on the patients to collect plain scan data and thin-layer CT data of arterial phase, portal venous phase and hepatic venous phase. The data were imported into the Medical Image Three-dimensional Visualization System (MI-3DVS) to perform image segmentation and three-dimensional visualization analysis of the liver, tumor tissues, portal venous system, hepatic venous system, hepatic arterial system and organs around the liver. The individualized liver segmentation, classification of the vascular and middle lobe tumor was performed and individualized volume was calculated. The surgical planning was formulated through simulating multiple surgery and the rational surgical procedure was selected. For patients undergoing complex hepatectomy, three-dimensional liver model was printed.ResultsThe construction of three-dimensional visualization model of all 56 patients was completed, which could clearly display the anatomical morphology of each vascular system, the location and size of tumor, and perform individual liver segmentation as well as vascular, middle lobe tumor classification. According to individualized volume calculation, the median total liver volume was 1 215 (1 025-1 856) ml, the liver tumor volume was 368 (25-653) ml and the virtual removal liver volume was 478 (125-854) ml. All the 56 patients received radical resection of tumor. The actual operation was in accordant with the preoperative surgical plan. The 3D printing model of 11 patients undergoing complex hepatectomy was exactly the same with that observed during the operation. The operations of all patients were completed successfully and no death was observed during the perioperative period. Six patients developed pleural effusion and one developed bile leakage on the liver cutting surface after operation. These patients were cured after symptomatic treatments.Conclusion Three-dimensional visualization platform for diagnosis and treatment of primary liver cancer can realize the precise preoperative diagnosis and intraoperative manipulation, thus enhances the success rate of surgery.

Objective To compare the effects of 3D laparoscopic hepatectomy (3D-LH) and open hepatectomy(OH)in glissonian access for hepatocellular carcinoma(HCC)on postoperative immunosuppression by analyzing cellular immune function. Methods During January 2014 to December 2017,sixty patients randomly scheduled to undergo hepatectomy were divided into 3D-LH group and OH group,with 30 patients in each group. All patients' peripheral blood was sampled to measure cell-mediated-immunologic markers(CD4+,CD8+T cell) before operation and in the mornings of the 1st,7thday after surgery. The effects of different operative methods on cellular immune function in patients organism were investigated. Results The decreased level in 3D-LH group was less than that in OH group in postoperative 1stday. The improvement in the 3D-LH group was more faster than that in the OH group on postoperative 7thday. There was statistical significance between the two groups(P<0.05), respectively. Conclusion When compared to open hepatectomy ,3D laparoscopy liver resection in glissonian approach for HCC,less effects in cellular immune function.