Hepatectomy guided by the diseased bile duct and hepatic vein for hepatolithiasis  

作　　者：Jianwei Li Xingru Wang Shuguo Zheng 

机构地区：[1]The Institute of Hepatobiliary Surgery of the Army,Southwest Hospital,Army Medical University,Chongqing,China [2]Department of Hepatobiliary Surgery,Qujing Central Hospital of Yunnan Regional Medical Center,Qujing,China

出　　处：《Hepatobiliary Surgery and Nutrition》2024年第3期566-568,共3页肝胆外科与营养（英文）

摘　　要：Hepatolithiasis(HL)is a common and serious disease with high incidence in Southeast Asian countries(1),especially in Southwest China,South China,and Southeast coastal areas of China.Based on the pathological characteristics of the segmented stone distribution and atrophy of the hepatic parenchyma,resection of the atrophied liver involving the diseased bile duct is the most effective and common surgical treatment for HL.As proposed by Shindoh et al.,hepatobiliary surgeons have used anatomic liver resection(AR)for hepatocellular carcinoma(HCC),which involves complete resection of the anatomic area supplied by the portal vein of the Glissonean branch(2).However,factors such as changes in bile fluid dynamics,stone compression,and chronic inflammation associated with HL lead to portal vein and hepatic artery stenosis and occlusion in some diseased areas,resulting in the diseased bile duct and hepatic vein(HV)becoming significant characteristic anatomical structures.In such cases,the effect and success rate of indocyanine green fluorescence staining are poor for navigation during HL surgery.Digital imaging techniques such as 3D visualization,3D printing,and artificial intelligence can facilitate preoperative evaluation but not accurate evaluation of all real anatomical structures and guidance of the transection plane.In such patients with HL,the lack of effective intrahepatic anatomic landmarks used during AR results in residual stones and diseased bile ducts and recurrence of stones.This necessitates repeated surgeries and affects postoperative recovery and patients’quality of life.Therefore,to allow for standardized and more accurate hepatectomy for HL and provide a theoretical basis for formulating corresponding treatment norms,we proposed and applied hepatectomy guided by the bile duct and HV(H-BV),that is by using the diseased bile duct tree and HV as anatomic landmarks.

关 键 词：Hepatolithiasis(HL) minimally invasive hepatectomy bile duct-HV space(BV space) 

分 类 号：R657.4[医药卫生—外科学] R657.3[医药卫生—临床医学]