摘要
目的总结三维可视化技术指导下腹腔镜联合胆道硬镜治疗肝内外胆管结石病人的临床应用效果。方法肝胆管结石病人45例,均采用腹部医学图像三维可视化软件对肝胆管结石进行三维可视化临床分析与术前规划,并将三维可视化模型带入手术室,指导实施3D腹腔镜联合胆道硬镜靶向碎石术。评价术中三维可视化图像模型显示情况,以及与实际肝胆管结石分布的一致性;统计手术时间、术中出血量、输血量、结石清除率、并发症发生率及围手术期病死率,复查后观察结石复发率。结果三维可视化图像模型再现病人肝脏、肝内脉管的解剖结构及肝内外胆管结石分布,术中真实显示与术前三维可视化模型一致,手术方法与术前计划一致。手术时间(125. 9±21. 2)分钟,术中出血量(38. 8±8. 5) ml,术中无大出血及输血;经MRCP检查结石清除率为100%;发生胆道损伤2例、胆漏1例,并发症发生率为6. 7%;本组无围手术期死亡病例。结石复发2例,复发率4. 4%。结论三维可视化技术可实现肝胆管结石的术前精确评估,指导术中腹腔镜、胆道硬镜下碎石、取石操作及肝段切除,有助于提高结石清除率,保障手术安全。
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 3 D 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.
作者
马先仕
陈洪刚
吴念寿
柯松
肖绪鹏
MA Xianshi;CHEN Honggang;WU Nianshou(Department Of Hepatological Surgery,Yangxin People＇s Hospital,Yangxin 435200,China)
出处
《临床外科杂志》
2018年第9期699-701,共3页
Journal of Clinical Surgery
关键词
三维可视化技术
腹腔镜
胆道硬镜
碎石术
肝胆管结石
three-dimensional visualization technology
laparoscopy
hepatic cholangioscopy
lithotripsy
hepatolithiasis
