title: 3D Reconstruction Aids Surgery For Complicated Hepatolithiasis.
abstract: OBJECTIVE
  Three-dimensional (3D) imaging may improve surgical interventions for complicated hepatolithiasis.
  
  
  METHODS
  Between July 2008 and December 2012 a total of 131 patients with complicated hepatolithiasis underwent surgical therapy in the Department of Hepatobiliary Surgery Zhujiang Hospital, Southern Medical University. 77 patients received preoperative planning using a computed tomography (CT)-based 3D reconstruction technique, and 54 received treatment based on preoperative planning with traditional imaging (CT, ultrasonography, magnetic resonance imaging/magnetic resonance cholangiography). Perioperative and long-term outcomes were analyzed.
  
  
  RESULTS
  3D reconstruction facilitated significantly more accurate diagnosis of pathological morphology than conventional imaging methods, as confirmed during surgery. Patients that received 3D reconstruction preoperative planning had significantly better clinical outcomes. The immediate stone clearance rates were 92.2% and 61.1%, respectively. Additional postoperative choledochoscopic lithotripsy raised the clearance rates to 94.8% and 81.5%, respectively. The hospital mortality rates were 0% and 1.9%, respectively, and the complication rates were 33.8% and 44.4%, respectively. With a median follow-up of 28 months (5-38 months), the long-term overall asymptomatic survival rates were 80.5% and 46.3%, respectively. 3D reconstruction preoperative planning was a significant prognostic protective factor of long-term asymptomatic survival for the patients with complicated hepatolithiasis (Cox regression analysis, RR = 0.348, 95% confidence interval 0.185-0.657, p = 0.001).
  
  
  CONCLUSIONS
  Surgical therapy conducted following preoperative planning using 3D reconstruction achieved better clinical outcomes than conventional imaging techniques. Whilst conventional imaging techniques accurately identify intrahepatic stones, they are less capable of identifying bile duct stricture.
authors.forename: Tian-Chong
authors.initials: TC
authors.lastname: Wu
authors.forename: Chi-Hua
authors.initials: CH
authors.lastname: Fang
authors.forename: Wen-Ying
authors.initials: WY
authors.lastname: Liu
authors.forename: Wei
authors.initials: W
authors.lastname: Cai
authors.forename: Ying-Fang
authors.initials: YF
authors.lastname: Fan
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
authors.forename: Ning
authors.initials: N
authors.lastname: Zeng
authors.forename: Shi-Zhen
authors.initials: SZ
authors.lastname: Zhong
authors.forename: Su-Su
authors.initials: SS
authors.lastname: Bao
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D020347:Lithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008107:Liver Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome