ABSTRACT
Objective:To analyze the clinical effect of real-time virtual sonography (RVS) surgical navigation combined with indocyanine green fluorescence imaging technology in the anatomical liver segmentectomy for hepatocellular carcinoma (HCC).Methods:The clinical data of 35 patients who underwent anatomical liver segmentectomy using RVS surgical navigation combined with indocyanine green fluorescence imaging technology in the Department of Hepatobiliary Surgery of Peking University International Hospital from January 2020 to January 2022 were retrospectively analyzed. There were 22 males and 13 females, aged (60.0±10.0) years. RVS is real-time virtual sonography, which fuses real-time intraoperative ultrasound images with corresponding preoperative CT or MRI images to guide the surgical plane. Methods of operation, time of operation, intraoperative blood loss, operative margin, hospital stay and postoperative complications were analyzed. Postoperative complications were graded by Clavien-Dindo system. The 1-year overall survival and tumor-free survival rates of patients were followed up by outpatient or telephone review.Results:Anatomical liver segmentectomy was performed on 36 patients, including 1 patient (2.9%) of segment Ⅱ, 1 patient (2.9%) of segment Ⅲ, 5 patients (14.3%) of segment Ⅳ, 6 patients (17.1%) of segment Ⅴ, 10 patients (28.6%) of segment Ⅵ, 7 patients (20.0%) of segment Ⅶ, 4 patients (11.4%) of segment Ⅷ, and 1 patient (2.9%) of segments Ⅴ+ Ⅷ. The operation time of 35 patients was (310.2±81.6) min, with an intraoperative blood loss of [ M( Q1, Q3)] 390.0(250.0, 500.0) ml. The hospital stay was (11.6±2.1) d. There was no postoperative death. Postoperative complications occurred in 3 cases (8.6%), of which 2 cases (5.7%) were ascites, Clavien-Dindo grade Ⅰ; Postoperative hemorrhage occurred in 1 case (2.9%), Clavien-Dindo grade Ⅱ. HCC was confirmed by pathology in all cases, and the operative margins were negative. The median follow-up time was 14 months (12 to 20 months). The 1-year overall survival rate after surgery was 100.0%(35/35), three patients (8.6%) had tumor recurrence, and the 1-year tumor-free survival rate was 91.4% (32/35). Conclusion:RVS surgical navigation combined with indocyanine green fluorescence imaging technology could be feasible in anatomical segmental hepatectomy for HCC.
ABSTRACT
Objective@#To investigate the application value of real-time virtual sonography(RVS)in the diagnosis and treatment of complicated hepatolithiasis.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People′s Hospital between October 2017 and March 2018 were collected. There were 3 males and 7 females, aged from 40 to 69 years, with an average age of 57 years. Patients received abdominal color Doppler ultrasound examination, magnetic resonance cholangiopancreatography, and upper abdominal spiral computed tomography (CT) thinly scanning + enhanced examination. Data of CT examination were imported into RVS. RVS was used to locate hepatolithiasis, relationship between stones and vessels, anatomy of bile ducts and vessels in hepatic hilus. Surgical methods included RVS-guided hilar cholangiotomy, biliary stricturoplasty, bilateral hepatojejunostomy, hepatic segmentectomy (lobectomy), and hepatolithotomy. Observation indicators: (1) surgical and postoperative situations; (2) typical case analysis; (3) follow-up. Follow-up using outpatient examination was performed to detect residual stones up to June 2019. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers.@*Results@#(1) Surgical and postoperative situations: 10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis, with successful match in RVS (difference between CT images and ultrosound images <2 mm). No residual stone was identified by choledochoscope during operation. The operation time and volume of intraoperative blood loss were 285 minutes (range, 210-360 minutes) and 200 mL (range, 100-600 mL), respectively. No blood transfusion was needed during the operations. The duration of hospital stay was 20.5 days (range, 14.0-29.0 days). There was no perioperative death. One patient had postoperative biliary leakage and abdominal infection, and was cured after conservative treatment. (2) Typical case analysis: the tenth patient, female, 60 years old, was diagnosed with complicated hepatolithiasis, and was prepared to undergo hepatolithotomy+ quadrate lobectomy and hilar cholangioplasty+ bilateral hepatojejunostomy. Preoperative CT images and intraoperative color Doppler ultrasound images of the patient were fused and matched on the sagittal section of the portal vein and the cross section of the right branch of portal vein, and stones and important vessels were marked on the images. After accurate positioning, a curette was used to remove the stones. Removal of biliary stones through hepatic parenchyma and peripheral dilated bile ducts was conducted at the site where stones obviously existed. After the stones were removed, the intrahepatic bile duct and hilar bile duct merged. The left end of the bile duct split was confirmed by real-time ultrasound. After location of portal vein was determined by ultrasound, vascular plastic surgery was perfomed to avoid stenosis. (3) Follow-up: 10 patients were followed up for 6-12 months, with a median follow-up time of 8 months. One of 10 patients was suspected residual stones at the right peripheral hepatic anterior lobe by postoperative angiography at 2 months after surgery, and was not removed stones by choledochoscope. The patient had no recurrent symptoms after T-tube removal. The other 9 patients had no residual stones.@*Conclusion@#RVS applied in complicated hepatolithiasis is helpful for the precise intraoperative diagnosis, and the surgical treatment can be safe and effective.
ABSTRACT
Objective To investigate the application value of real-time virtual sonography (RVS)in the diagnosis and treatment of complicated hepatolithiasis.Methods The retrospective and descriptive study was conducted.The clinical data of 10 patients with complicated hepatolithiasis who were admitted to Hunan Provincial People's Hospital between October 2017 and March 2018 were collected.There were 3 males and 7 females,aged from 40 to 69 years,with an average age of 57 years.Patients received abdominal color Doppler ultrasound examination,magnetic resonance cholangiopancreatography,and upper abdominal spiral computed tomography (CT) thinly scanning +enhanced examination.Data of CT examination were imported into RVS.RVS was used to locate hepatolithiasis,relationship between stones and vessels,anatomy of bile ducts and vessels in hepatic hilus.Surgical methods included RVS-guided hilar cholangiotomy,biliary stricturoplasty,bilateral hepatojejunostomy,hepatic segmentectomy (lobectomy),and hepatolithotomy.Observation indicators:(1) surgical and postoperative situations;(2) typical case analysis;(3) follow-up.Follow-up using outpatient examination was performed to detect residual stones up to June 2019.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results (1) Surgical and postoperative situations:10 patients underwent RVS-guided surgeries successfully for complicated hepatolithiasis,with successful match in RVS (difference between CT images and ultrosound images ＜ 2 mm).No residual stone was identified by choledochoscope during operation.The operation time and volume of intraoperative blood loss were 285 minutes (range,210-360 minutes) and 200 mL (range,100-600 mL),respectively.No blood transfusion was needed during the operations.The duration of hospital stay was 20.5 days (range,14.0-29.0 days).There was no perioperative death.One patient had postoperative biliary leakage and abdominal infection,and was cured after conservative treatment.(2) Typical case analysis:the tenth patient,female,60 years old,was diagnosed with complicated hepatolithiasis,and was prepared to undergo hepatolithotomy + quadrate lobectomy and hilar cholangioplasty+bilateral hepatojejunostomy.Preoperative CT images and intraoperative color Doppler ultrasound images of the patient were fused and matched on the sagittal section of the portal vein and the cross section of the right branch of portal vein,and stones and important vessels were marked on the images.After accurate positioning,a curette was used to remove the stones.Removal of biliary stones through hepatic parenchyma and peripheral dilated bile ducts was conducted at the site where stones obviously existed.After the stones were removed,the intrahepatic bile duct and hilar bile duct merged.The left end of the bile duct split was confirmed by real-time ultrasound.After location of portal vein was determined by ultrasound,vascular plastic surgery was perfomed to avoid stenosis.(3) Follow-up:10 patients were followed up for 6-12 months,with a median followup time of 8 months.One of 10 patients was suspected residual stones at the right peripheral hepatic anterior lobe by postoperative angiography at 2 months after surgery,and was not removed stones by choledochoscope.The patient had no recurrent symptoms after T-tube removal.The other 9 patients had no residual stones.Conclusion RVS applied in complicated hepatolithiasis is helpful for the precise intraoperative diagnosis,and the surgical treatment can be safe and effective.