Application of Digital Technology Assisted Minimally Invasive Surgery in Diagnosis and Treatment of Hepatolithiasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FAN Yingfang , FANG Chihua , XIANG Nan , CHEN Jianxin.

Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China;

Corresponding author：

Keywords：

Hepatolithiasis; Three-dimensional reconstruction; Digitizing; Minimally Invasive Surgery; Emulational surgery

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ObjectiveTo study the clinical value of digital technology assisted minimally invasive surgery in diagnosis and treatment of hepatolithiasis. MethodsThe image data of 64-slice spiral CT scanning were obtained from five patients of complicated hepatolithiasis and introduced into medical image three-dimensional visualization system (MI-3DVS) for three-dimensional reconstruction. On the basis of the data of three-dimensional reconstruction, minimally invasive surgical planning of preoperation was made to obtain reasonable hepatectomy and cholangiojejunostomy, and then preoperative emulational surgery was carried out to minimize the extent of tissue damage and provide guidance to actual operation. ResultsLiver, biliary system, stone, blood vessel, and epigastric visceral organ were successfully reconstructed by MI-3DVS, which showed clearly size, number, shape, and space distribution of stone, and location, degree, length, and space distribution of biliary stricture, and anatomical relationship of ducts and vessels. The results of three-dimensional reconstruction were successfully confirmed by actual operation, which was in accordance with emulational surgery. There was no operative complication. No retained stone in internal and external bile duct was found by Ttube or other supporting tube cholangiography on one month after operation. ConclusionThree-dimensional digitizing reconstruction and individual emulational surgery have important significance in diagnosis and treatment of complicated hepatolithiasis by minimally invasive technique.

Citation： FAN Yingfang,FANG Chihua,XIANG Nan,CHEN Jianxin.. Application of Digital Technology Assisted Minimally Invasive Surgery in Diagnosis and Treatment of Hepatolithiasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(7): 688-693. doi: Copy

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11.	郭成伟, 梁文, 全显跃, 等. 64层螺旋CT门静脉三维成像变异分析及其在临床中的应用 [J]. 中国实用外科杂志, 2008, 28(8): 641643.
12.	Zhou ZM, Fang CH, Huang LW, et al. Three dimensional reconstruction of the pancreas based on the virtual Chinese human—female number 1 [J]. Postgrad Med J, 2006, 82(968): 392396.
13.	周五一, 方驰华, 黄立伟, 等. 肝脏管道灌注后数字化虚拟肝脏及其手术 [J]. 第四军医大学学报, 2006, 27(8): 712716.
14.	Fang CH, Huang YP, Chen ML, et al. Digital medical technology based on 64slice computed tomography in hepatic surgery [J]. Chin Med J (Engl), 2010, 123(9): 11491153.
15.	Fang CH, Li XF, Li Z, et al. Application of medical image processing system in liver transplantation [J]. Hepatobiliary Pancreat Dis Int, 2010, 9(4): 370375.
16.	方驰华, 鲁朝敏, 黄燕鹏, 等. 数字医学技术在肝癌外科治疗中的应用价值研究 [J]. 中华外科杂志, 2009, 47(7): 523526.
17.	方驰华, 刘宇斌, 黄燕鹏, 等. 64排螺旋CT三维重建和胰腺可视化仿真手术的应用研究 [J]. 中国实用外科杂志, 2008, 28(9): 757760.
18.	梁力建, 汤地. 肝胆管结石影像学诊断方法的评价和合理选择 [J]. 中国普外基础与临床杂志, 2006, 13(4): 378379.
19.	孙学军, 卢乐, 石景森. 肝胆管结石的微创外科治疗进展 [J]. 中国普外基础与临床杂志, 2006, 13(4): 403405.
20.	韦杨年, 黄海, 莫世发, 等. 精准肝切除在肝胆管结石病的临床应用 [J]. 中国普外基础与临床杂志, 2011, 18(1): 6772.
21.	程南生. 肝胆管结石并发症的防治 [J]. 中国普外基础与临床杂志, 2006, 13(4): 380381.

1. 徐大华. 从微创外科技术应用纵观微创外科理念发展 [J]. 中国微创外科杂志, 2011, 11(2): 102103.
2. 黄志强. 3D时代的肝胆胰外科：从“阿童木”到“阿凡达” [J/OL]. 中华腔镜外科杂志（电子版）, 2010, 3(3): 218220.
3. 方驰华, 项楠. 数字化微创技术在肝胆胰外科的应用 [J]. 中国微创外科杂志, 2011, 11(1): 1519.
4. 中华医学会外科学分会胆道外科学组. 肝胆管结石病诊断治疗指南 [J]. 中华消化外科杂志, 2007, 6(2): 156161.
5. 方驰华, 常旭, 鲁朝敏, 等. 肝内外胆管结石64排CT数据三维重建及其临床意义 [J]. 南方医科大学学报, 2008, 28(3): 370372.
6. 方驰华, 项楠, 范应方, 等. 64层螺旋CT三维成像在消化系统疾病诊治中的临床应用价值 [J]. 中华外科杂志, 2007, 45(13): 909912.
7. 廖其光, 鲍苏苏, 潘家辉, 等. 基于VTK肝脏三维模型可视化研究与实现 [J]. 计算机与数字工程, 2008, 36(2): 102104,112.
8. 彭丰平, 鲍苏苏. 肝脏虚拟手术中的关键技术研究与实现 [J]. 现代计算机（专业版）, 2008, (5): 1013.
9. 黄志强. 微创外科与外科微创化—21世纪外科的主旋律 [J]. 中华外科杂志, 2002, 40(1): 912.
10. 黄志强. 微创外科——不断发展的技术与理念 [J]. 中国实用外科杂志, 2010, 30(3): 161163.
11. 郭成伟, 梁文, 全显跃, 等. 64层螺旋CT门静脉三维成像变异分析及其在临床中的应用 [J]. 中国实用外科杂志, 2008, 28(8): 641643.
12. Zhou ZM, Fang CH, Huang LW, et al. Three dimensional reconstruction of the pancreas based on the virtual Chinese human—female number 1 [J]. Postgrad Med J, 2006, 82(968): 392396.
13. 周五一, 方驰华, 黄立伟, 等. 肝脏管道灌注后数字化虚拟肝脏及其手术 [J]. 第四军医大学学报, 2006, 27(8): 712716.
14. Fang CH, Huang YP, Chen ML, et al. Digital medical technology based on 64slice computed tomography in hepatic surgery [J]. Chin Med J (Engl), 2010, 123(9): 11491153.
15. Fang CH, Li XF, Li Z, et al. Application of medical image processing system in liver transplantation [J]. Hepatobiliary Pancreat Dis Int, 2010, 9(4): 370375.
16. 方驰华, 鲁朝敏, 黄燕鹏, 等. 数字医学技术在肝癌外科治疗中的应用价值研究 [J]. 中华外科杂志, 2009, 47(7): 523526.
17. 方驰华, 刘宇斌, 黄燕鹏, 等. 64排螺旋CT三维重建和胰腺可视化仿真手术的应用研究 [J]. 中国实用外科杂志, 2008, 28(9): 757760.
18. 梁力建, 汤地. 肝胆管结石影像学诊断方法的评价和合理选择 [J]. 中国普外基础与临床杂志, 2006, 13(4): 378379.
19. 孙学军, 卢乐, 石景森. 肝胆管结石的微创外科治疗进展 [J]. 中国普外基础与临床杂志, 2006, 13(4): 403405.
20. 韦杨年, 黄海, 莫世发, 等. 精准肝切除在肝胆管结石病的临床应用 [J]. 中国普外基础与临床杂志, 2011, 18(1): 6772.
21. 程南生. 肝胆管结石并发症的防治 [J]. 中国普外基础与临床杂志, 2006, 13(4): 380381.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Digital Technology Assisted Minimally Invasive Surgery in Diagnosis and Treatment of Hepatolithiasis

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