关键词: 腹腔镜手术, 急性胆囊炎, 血清细胞间黏附分子1, 人基质金属蛋白酶9, 血管内皮生长因子

Abstract:   [Abstract] Objective To analyze the clinical application effects of laparoscopy combined with hepatic cholangioscopy under the guidance of threedimensional visualization technology in the treatment of patients with hepatolithiasis.Methods 45 cases of patients with hepatolithiasis admitted were given the threedimensional visualization software for hepatolithiasis to have threedimensional visualization clinical analysis and preoperative planning.And the threedimensional visualization model was taken into the operating room and used to guide the implementation of the 3D laparoscopy combined with hepatic cholangioscopy targeted lithotripsy.The intraoperative display situation of the threedimensional visualization model and its consistency with the actual distribution of hepatolithiasis were evaluated，and the operative time，intraoperative blood loss，blood transfusion，stone clearance rate，the incidence rates of complications and perioperative mortality rate were recorded，and the stones recurrence rate was measured at postoperative review.Results The liver，intrahepatic vasculature anatomy structures and hepatolithiasis distribution could be truly  represented in a stereoscopic way by threedimensional visualization image model，and the actual intraoperative display was identical with preoperative threedimensional visualization model，and the surgical approaches were consistent with the preoperative planning.The operative time was （125.9±21.2）min，and intraoperative blood loss was （38.8±8.5）mL，and there was no intraoperative massive haemorrhage and transfusion cases.The stone clearance rate was 100% confirmed by MRCP.There were 2 cases of bile duct injury and 1 case of bile leakage，and they were recovered after symptomatic treatment，and the incidence rate of complications was 6.7%.There was no perioperative deaths.There were 2 cases of stone recurrence with the recurrence rate of 4.4%.Conclusion Threedimensional visualization technology can have accurate preoperative evaluation of hepatolithiasis，and guide the lithotripsy，stone removal and hepatic resection by intraoperative laparoscopy and hepatic cholangioscopy，which can help improve the stone clearance rate and ensure the safety of the operation.

Key words: laparoscopic surgery, acute cholecystitis, ICAM1, MMP9, VEGF