Ye YQ, Li PH, Ding ZW, Zhang SF, Li RQ, Cao YW. Application of DynaCT biliary soft tissue reconstruction technology in diagnosis and treatment of hepatolithiasis. World J Gastrointest Surg 2025; 17(1): 98283 [DOI: 10.4240/wjgs.v17.i1.98283]
Corresponding Author of This Article
Ya-Wen Cao, Department of Emergency Medicine, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 2 Hengluo Road, Yuancun, Tianhe District, Guangzhou 510655, Guangdong Province, China. caoyawen0804@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jan 27, 2025; 17(1): 98283 Published online Jan 27, 2025. doi: 10.4240/wjgs.v17.i1.98283
Application of DynaCT biliary soft tissue reconstruction technology in diagnosis and treatment of hepatolithiasis
Yong-Qing Ye, Pei-Heng Li, Zhao-Wei Ding, Sheng-Feng Zhang, Rong-Qi Li, Ya-Wen Cao
Yong-Qing Ye, Department of Hepatobiliary Surgery, The Second People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
Pei-Heng Li, Department of Oncology, Foshan Nanhai District Fifth People's Hospital, Foshan 528000, Guangdong Province, China
Zhao-Wei Ding, Sheng-Feng Zhang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
Rong-Qi Li, Department of Hepatobiliary Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China
Ya-Wen Cao, Department of Emergency Medicine, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Co-first authors: Yong-Qing Ye and Pei-Heng Li.
Author contributions: Ye YQ, Li PH, and Cao YW designed the research; Ye YQ and Li PH performed the research; Ding ZW, Zhang SF, and Li RQ contributed new analytic tools; Ye YQ and Li PH analyzed the data; Ye YQ and Li PH wrote the paper. All the authors have read and approved the final manuscript. Ye YQ and Li PH contributed equally to this work as co-first authors.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital of Guangzhou Medical University.
Informed consent statement: Informed written consent was obtained from the patient for publication of this research and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests to disclose.
Data sharing statement: The datasets used during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Wen Cao, Department of Emergency Medicine, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 2 Hengluo Road, Yuancun, Tianhe District, Guangzhou 510655, Guangdong Province, China. caoyawen0804@163.com
Received: June 23, 2024 Revised: October 3, 2024 Accepted: November 8, 2024 Published online: January 27, 2025 Processing time: 187 Days and 4.4 Hours
Abstract
BACKGROUND
Hepatobiliary stone disease involves an intrahepatic bile duct stone that occurs above the confluence of the right and left hepatic ducts. One-step percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) using the percutaneous transhepatic one-step biliary fistulation (PTOBF) technique enables the clearing of intrahepatic stones and the resolution of strictures. However, hepatolithiasis with associated strictures still has high residual and recurrence rates after one-step PTCSL. DynaCT can achieve synchronized acquisition with a flat-panel detector during C-arm rotation. The technical approach and application value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis were evaluated in this study.
AIM
To explore the value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis, and to assess the feasibility and effectiveness of the PTOBF technique guided by DynaCT biliary soft tissue reconstruction technology.
METHODS
The clinical data of 140 patients with complex biliary stenosis disease combined with bile duct stenosis who received PTOBF and were admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2020 to December 2024 were collected. The patients were divided into two groups: DynaCT-PTOBF group (70 patients) and conventional PTOBF group (70 patients). These groups were compared in terms of the preoperative bile duct stenosis, location of the liver segment where the stone was located, intraoperative operative time, immediate stone retrieval rate, successful stenosis dilatation rate, postoperative complication rate, postoperative reoperation rate, stone recurrence rate, and stenosis recurrence rate.
RESULTS
DynaCT biliary soft tissue reconstruction technology was successfully performed in 70 patients. The DynaCT-PTOBF group had a higher detection rate of target bile ducts where bile duct stones and biliary strictures were located than the PTOBF group. Compared with the PTOBF group, the DynaCT-PTOBF group was characterized by a significantly greater immediate stone removal rate (68.6% vs 50.0%, P = 0.025), greater immediate stenosis dilatation success rate (72.9% vs 55.7%, P = 0.034), greater final stenosis release rate (91.4% vs 75.7%, P = 0.012), shorter duration of intraoperative hemorrhage (3.14 ± 2.00 vs 26.5 ± 52.1, P = 0.039), and lower incidence of distant cholangitis (2.9% vs 11.4%, P = 0.49). There were no significant differences between the two groups in terms of the final stone removal rate, reoperation rate, or long-term complication incidence rate.
CONCLUSION
DynaCT biliary soft tissue reconstruction technology guiding the PTOBF technique in patients with hepatolithiasis with bile duct stenosis is feasible and accurate. It may be beneficial for optimizing the preoperative evaluation of the PTOBF technique.
Core Tip: DynaCT was used for the first time in patients with hepatolithiasis with biliary stenosis. Compared with computed tomography, DynaCT for biliary reconstruction results in higher-quality, three-dimensional biliary, blood vessel, and liver images. Based on DynaCT biliary model, one-step percutaneous transhepatic cholangioscopic lithotripsy has the potential to improve the stone clearance rate, shorten the stone clearance time, and reduce the reoperation rate.
