In this editorial,we comment on the article by Ye et al.We specifically focused on the novel use of DynaCT biliary soft tissue reconstruction technology in the diagnosis and treatment of hepatolithiasis with bile duct...In this editorial,we comment on the article by Ye et al.We specifically focused on the novel use of DynaCT biliary soft tissue reconstruction technology in the diagnosis and treatment of hepatolithiasis with bile duct stenosis,which is an innovative approach for enhancing the preoperative evaluation and surgical outcomes in hepatolithiasis.This study also highlights the limitations of conventional imaging techniques such as computed tomography and magnetic resonance cholangiopancreatography,which have low sensitivity for small stones and complex biliary strictures.Given the intricate anatomy of the biliary system and the challenges posed by limited visualization using conventional methods,DynaCT addresses these issues by providing high-resolution,three-dimensional reconstruction of the bile ducts,stones,and vascular structures,thus improving anatomical clarity and enabling precise surgical planning.We also focused specifically on the limitations of DynaCT,such as the need for specialized equipment and patient selection criteria,as well as its advantages and disadvantages compared with conventional PTOBF approaches.Overall,DynaCT represents a significant advancement in hepatolithiasis management,with the potential to become a standard imaging modality for safer and more effective biliary procedures.展开更多
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...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 DynaCTPTOBF 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.展开更多
文摘In this editorial,we comment on the article by Ye et al.We specifically focused on the novel use of DynaCT biliary soft tissue reconstruction technology in the diagnosis and treatment of hepatolithiasis with bile duct stenosis,which is an innovative approach for enhancing the preoperative evaluation and surgical outcomes in hepatolithiasis.This study also highlights the limitations of conventional imaging techniques such as computed tomography and magnetic resonance cholangiopancreatography,which have low sensitivity for small stones and complex biliary strictures.Given the intricate anatomy of the biliary system and the challenges posed by limited visualization using conventional methods,DynaCT addresses these issues by providing high-resolution,three-dimensional reconstruction of the bile ducts,stones,and vascular structures,thus improving anatomical clarity and enabling precise surgical planning.We also focused specifically on the limitations of DynaCT,such as the need for specialized equipment and patient selection criteria,as well as its advantages and disadvantages compared with conventional PTOBF approaches.Overall,DynaCT represents a significant advancement in hepatolithiasis management,with the potential to become a standard imaging modality for safer and more effective biliary procedures.
文摘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 DynaCTPTOBF 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.
