3D和超声引导经皮肝Ⅰ期造瘘联合硬镜治疗复杂肝胆管结石的临床价值

doi:10.13418/j.issn.1001-165x.2020.03.015

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (3): 321-326.doi: 10.13418/j.issn.1001-165x.2020.03.015

3D和超声引导经皮肝Ⅰ期造瘘联合硬镜治疗复杂肝胆管结石的临床价值

方兆山¹，　黄海¹，　杨剑²

1.广西医科大学第五附属医院，南宁 530022； 2.南方医科大学珠江医院肝胆外科，广州 510282

收稿日期:2019-09-19 出版日期:2020-05-25 发布日期:2020-06-02
通讯作者: 杨剑，副主任医师，硕士生导师， E-mail: yangjian 486@126.com
作者简介:方兆山（1981-），副教授，副主任医师，研究方向：数字医学技术在肝胆胰腺外科的应用，E-mail: fangzhsh_dr@126.com
基金资助:
国家自然科学基金青年基金项目（编号81601576）；广东省公益研究与能力建设专项（2016A020220013）；广州市产学研协同创新重大专项（201704020141）；广西卫健委科研课题（Z20180668）

Application of three-dimensional visualization combined with ultrasound-guided percutaneous transhepatic one-step biliary fistulation lithotripsy with rigid choledochoscope for treating complex hepatolithiasis

FANG Zhao-shan¹， HUANG Hai¹， YANG Jian²

1. Department of Hepatobiliary Surgery, the fifth Affiliated Hospital of Guangxi Medical University，Nanning 530022, China；2.Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China

Received:2019-09-19 Online:2020-05-25 Published:2020-06-02

摘要/Abstract

摘要： 目的　探讨三维可视化（3D）技术和超声（US）技术引导经皮肝Ⅰ期造瘘联合硬镜靶向碎石治疗复杂肝胆管结石的价值。方法　选取65例复杂性肝胆管结石患者，随机分2组，观察组（3D+US组）：3D和US技术引导经皮肝Ⅰ期造瘘联合硬镜治疗的患者33例；对照组（US组）：US引导经皮肝Ⅰ期造瘘联合硬镜治疗的患者32例。比较两组患者的手术时间、手术出血量、结石清除率、术后住院时间、术后并发症。结果　观察组的手术时间（65.6±12.9 min vs 74.5±13.6 min，t=2.686，P=0.009）短于对照组，差异性比较具有统计学意义（P<0.05）；两组的手术出血量（22.2±5.4 ml vs 25.7±10.2 ml，t =-1.748，P=0.085）、结石清除率（93.9% vs 90.6%，χ2=0.251，P=0.616）、术后住院时间（6.8±2.1 d vs 7.2±2.4d，t=0.751，P=0.456）、并发症发生率（9.1% vs 12.5%，χ2=0.196，P=0.658）等，差异性比较无统计学意义（P>0.05）。结论　3D和超声引导经皮肝Ⅰ期造瘘联合硬镜靶向治疗复杂肝胆管结石是一种微创、安全、高效的方法，具有一定的应用前景。

关键词: 复杂肝胆管结石, 　经皮肝Ⅰ期造瘘, 　硬镜, 　三维可视化技术, 　3D

Abstract: Objective　To explore the value of three-dimensional (3D) visualization technique combined with ultrasound (US) guided percutaneous transhepatic one-step biliary fistulation lithotripsy for the treatment of complex hepatolithiasis.　Methods　Sixty-five patients with complex hepatolithiasis were collected, which were divided into 2 groups randomly: an observation group and a control group. 33 cases were the observation group (3D+US group), which were treated by 3D technique combined with US-guided percutaneous transhepatic one-step biliary fistulation lithotripsy with rigid choledochoscope; and the other 32 cases were the control group (US group) which were treated by US. The surgery time, surgical bleeding loss, stone clearance rate, postoperative hospitalization time, postoperative complications of the two groups were compared and analyzed.　Results　The surgery time of the 3D+US group （65.6±12.9 min vs 74.5±13.6 min, t=2.686, P=0.009）were shorter than that of the US group, which the differences were statistically significant (P<0.05); but compared with two groups of surgical bleeding loss（22.2±5.4 ml vs 25.7±10.2 ml，t =-1.748，P=0.085）, clearance of stones （93.9% vs 90.6%，χ2=0.251，P=0.616）, postoperative hospitalization time（6.8±2.1d vs 7.2±2.4d，t=0.751，P=0.456） and postoperative complications（9.1% vs 12.5%， χ2=0.196 ，P=0.658）, there were no statistical difference (P>0.05). 　Conclusions　3D visualization combined with US-guided percutaneous transhepatic one-step biliary fistulation is a safe, minimally invasive and highly efficient method for the treatment of complex hepatolithiasis, which may have its potential application in clinical prospects.

Key words: Complex hepatolithiasis;　Percutaneous transhepatic one-step biliary fistulation;　Rigid choledochoscopy;　Three-dimensional visualization technique, 　3D

中图分类号:

方兆山, 黄海, 杨剑. 3D和超声引导经皮肝Ⅰ期造瘘联合硬镜治疗复杂肝胆管结石的临床价值[J]. 中国临床解剖学杂志, 2020, 38(3): 321-326.

FANG Zhao-shan, HUANG Hai, YANG Jian. Application of three-dimensional visualization combined with ultrasound-guided percutaneous transhepatic one-step biliary fistulation lithotripsy with rigid choledochoscope for treating complex hepatolithiasis[J]. Chinese Journal of Clinical Anatomy, 2020, 38(3): 321-326.

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3D和超声引导经皮肝Ⅰ期造瘘联合硬镜治疗复杂肝胆管结石的临床价值

Application of three-dimensional visualization combined with ultrasound-guided percutaneous transhepatic one-step biliary fistulation lithotripsy with rigid choledochoscope for treating complex hepatolithiasis

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