duct blood supply. Meanwhile, it can show the stereoscopic anatomical relationship between bile duct stones, tumors and surrounding organs and blood vessels.

In the lower extrahepatic bile duct blood supply, there were 13 cases of type IA (31.7%) (Fig.9.26), 13 cases of type IB (31.7%) (Fig. 9.27), 4 cases of type IC (9.8%)

All the 41 cases underwent surgical treatment, including choledocholithotomy in 15 cases (3 cases of left extrahepatic

the digital classication of extrahepatic bile duct blood sup­ply can be performed before operation, the operative method can be selected according to the type of classication. When the blood supply of the lower extrahepatic bile duct is classi­ed as type I, it is mainly supplied by the superior posterior pancreaticoduodenal artery, whose arch should be preserved during operation. For type II, the main supply of bile duct was the gastroduodenal artery and pancreaticoduodenal anterior artery. It was often suggested that the posterior pan­creaticoduodenal artery arch was small, and the anterior pan­creaticoduodenal artery arch should be preserved to ensure the blood supply of duodenum and bile duct. If type III, the cholecystic artery originated from the gastroduodenal artery, goes up to the upper right, and supplies blood to the bile duct. It is necessary to avoid the destruction of the ascending

sis and biliary stula.

bile duct. A patient with lower choledocholithiasis was scanned and a 3D model constructed (Fig.9.34). The model showed the right hepatic artery and the proper hepatic artery supplying the anterior wall of the extrahepatic bile duct (Fig.9.34). The location of the incision was selected accord­ing to the model so as to avoid complications such as biliary stula or late biliary stricture, injury to the anterior wall of the blood supply artery was avoided when the extrahepatic bile duct was cut open, sutured, and closed.

making of cholangioenterostomy and the location of the biliary anastomosis. Typical case 1 (Resource 9.1: case 1): The patient was diagnosed with inammatory stenosis of the lower common bile duct. Conservative treatment and endoscopic duodenal papilla incision were ineffective, and bile drainage was needed through choledochojejunostomy. The preoperative 3D model of the extrahepatic bile duct supply suggested that the common hepatic bile duct blood supply was composed of “9 o’clock” artery and right hepatic artery formed by the main gallbladder artery. The lower part of the common bile duct blood supply was sup­plied by the superior and posterior pancreaticoduodenal artery, but no obvious arterial blood supply was found in the upper part of the common bile duct and duodenum. Above all, the extrahepatic bile duct was cut off at the level of the common bile duct with abundant blood supply, and end-to-side cholangiojejunostomy was performed. Typical case two (Resource 9.1: case 2) was also diagnosed with inammatory stenosis in the lower common bile duct, but the individual 3D model suggested that the extrahepatic bile duct blood supply of the patient was variable, and the cholecystic artery originated from the gastroduodenal artery. The intestinal artery, which is close to the right-side wall of the extrahepatic bile duct, enters the gallbladder and forms a “9 o’clock” artery for ascending blood supply. If the patient receives an extrahepatic bile duct transection and end-to-side cholangiojejunostomy, the arterial blood supply may be destroyed at 9 o’clock. Therefore, side- to­side cholangiojejunostomy was selected as the operative method.