三维可视化指导不同手术方法联合硬胆道镜治疗复杂性肝胆管结石临床研究

doi:10.3969/j.issn.1672-5069.2018.04.032

摘要/Abstract

摘要： 目的探讨三维可视化指导下不同手术方法联合硬胆道镜治疗复杂性肝胆管结石患者的效果。方法 2014年3月~2016年3月我院诊治的58例复杂性肝胆管结石患者,在三维可视化系统行三维重建和术前仿真,采用不同手术方法联合硬胆道镜取石治疗。结果所有患者术前三维可视化重建情况与术中所见大致相符,实际手术方案与仿真手术方案符合率为100%。31例因存在萎缩肝叶或肝段和难以取净的多发结石,行肝部分切除术,预切除体积为（241.6±26.2） mm³,与实际切除体积相符;27例行经胆总管切开探查取石。36例行胆管狭窄扩张术,并予以置入胆管支撑管重建胆道;在行经胆总管切开探查取石患者中,均一期术中经硬胆道镜取尽结石,经T管造影检查无结石残留,其中2例因化脓性胆囊炎不能一期处理,1例因高龄和结石过多,先行部分取石。后3例患者均行二期三维可视化指导下经T管窦道硬胆道镜靶向碎石、取石,均取尽结石;随访9~31个月,无1例结石复发。结论三维可视化指导个性化手术联合硬胆道镜取石治疗复杂性肝胆管结石患者安全有效,可提高结石清除率,降低远期复发率。

关键词: 肝胆管结石, 三维可视化CT重建, 硬胆道镜, 治疗

Abstract: Objective To investigate the efficacy of rigid choledochoscopy and three-dimensional visualization-guided surgery in the treatment of patients with complex intrahepatic cholelithiasis. Methods 58 patients with complex intrahepatic cholelithiasis were recruited in our hospital between March 2014 and March 2016. The CT scan was reconstructed by three-dimensional visualization,and partial hepatectomy or common bile duct incision exploration was performed based on the simulation surgery. Results The real surgery was in 100% conformity with the preoperational three-dimensional visualization reconstruction;31 patients received partial hepatectomy with the incised volume of （241.6±26.2） mm³ in accordance with the reconstruction,and 27 patients received common bile duct incision exploration;36 patients underwent bile duct dilatation and bile duct stent for bile duct patency;bile duct stones were removed under rigid choledochoscopy in one-stage surgery,except 3 cases were removed in second stage surgery because of pyogenic cholecystitis or elderly age with multiple stones; there was no stone recurrence during 9 to 31 months of follow-up. Conclusion Three-dimensional visualization-guided individualized surgery and application of rigid choledochoscopy is safe and effective in the treatment of patients with complex intrahepatic cholelithiasis. The regimen can improve the rate of stone removal and reduce the long-term recurrence.

Key words: Cholelithiasis, Three-dimensional visualization, Rigid choledochoscopy, Therapy

张庆勇, 周黔川, 赵松. 三维可视化指导不同手术方法联合硬胆道镜治疗复杂性肝胆管结石临床研究[J]. 实用肝脏病杂志, 2018, 21(4): 613-616.

Zhang Qingyong, Zhou Qianchuan, Zhao Song. Rigid choledochoscopy and three-dimensional visualization-guided surgery in the treatment of patients with complex intrahepatic cholelithiasis[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(4): 613-616.

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