中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
4期
281-285
,共5页
肖林峰%苏昭杰%李文岗%沈东炎%万云燕%高鹏%段朋%黄军利
肖林峰%囌昭傑%李文崗%瀋東炎%萬雲燕%高鵬%段朋%黃軍利
초림봉%소소걸%리문강%침동염%만운연%고붕%단붕%황군리
肝胆管结石病%三维可视化系统%纤维胆道镜
肝膽管結石病%三維可視化繫統%纖維膽道鏡
간담관결석병%삼유가시화계통%섬유담도경
Hepatolithiasis%Three-dimensional visualization system%Choledochofiberscope
目的 探讨三维可视化系统联合纤维胆道镜在肝胆管结石病治疗中的应用价值.方法 回顾性分析2012年1月至2013年1月厦门大学附属成功医院收治的30例肝胆管结石病患者的临床资料.所有患者术前行CT检查,应用IQQA-Liver系统将CT二维图像转换成三维图像,了解结石的位置及与周围毗邻关系.在三维图像上制订预手术方案,测量肝脏体积、预切除肝脏体积.术中采用传统方法取石联合使用纤维胆道镜行胆管探查、冲洗,胆道镜下碎石、取石.术后比较实际手术方案与预手术方案的区别.复查CT计算结石残留率,计算实际切除肝脏体积.实际切除肝脏体积与术前预切除肝脏体积的相关性检验采用Pearson等级相关分析.结果 30例患者均成功完成三维重建,其结果清楚地显示结石大小、位置及其与周围血管、胆管的毗邻关系.其中拟行胆总管切开取石24例,肝实质切开取石6例,肝部分切除术15例,胆管狭窄成形+胆管空肠Roux-en-Y吻合术16例.三维重建测得拟行肝部分切除术的15例患者肝脏体积为(1 390±148) mL,预切除肝脏体积为(275±156)mL.术前三维可视化重建对胆管、结石及重要血管的解剖学评估结果与术中所见大致相符.30例患者实际行胆总管切开取石24例,肝实质切开取石6例,肝部分切除术15例,胆肠吻合16例.规划手术方案与实际手术方式符合率为100.0％(30/30).患者均常规进行胆道镜探查,其中经胆道镜取石23例.术中实际切除肝脏体积为(261±148) mL.预切除肝脏体积的平均误差率为5.4％.术前预切除肝脏体积与术后实际切除肝脏体积呈正相关(r=0.902,P＜0.05).患者手术时间为(121 ±65) min,术中出血量为(158±78)mL.30例患者术后均未出现胆汁漏,切口感染发生率为3.3％(1/30).术后2周至3个月复查CT或胆道造影,证实结石取尽27例,结石残留率为10.0％(3/30).结论 三维可视化系统联合纤维胆道镜在肝胆管结石病治疗中具有一定的临床应用及指导价值.
目的 探討三維可視化繫統聯閤纖維膽道鏡在肝膽管結石病治療中的應用價值.方法 迴顧性分析2012年1月至2013年1月廈門大學附屬成功醫院收治的30例肝膽管結石病患者的臨床資料.所有患者術前行CT檢查,應用IQQA-Liver繫統將CT二維圖像轉換成三維圖像,瞭解結石的位置及與週圍毗鄰關繫.在三維圖像上製訂預手術方案,測量肝髒體積、預切除肝髒體積.術中採用傳統方法取石聯閤使用纖維膽道鏡行膽管探查、遲洗,膽道鏡下碎石、取石.術後比較實際手術方案與預手術方案的區彆.複查CT計算結石殘留率,計算實際切除肝髒體積.實際切除肝髒體積與術前預切除肝髒體積的相關性檢驗採用Pearson等級相關分析.結果 30例患者均成功完成三維重建,其結果清楚地顯示結石大小、位置及其與週圍血管、膽管的毗鄰關繫.其中擬行膽總管切開取石24例,肝實質切開取石6例,肝部分切除術15例,膽管狹窄成形+膽管空腸Roux-en-Y吻閤術16例.三維重建測得擬行肝部分切除術的15例患者肝髒體積為(1 390±148) mL,預切除肝髒體積為(275±156)mL.術前三維可視化重建對膽管、結石及重要血管的解剖學評估結果與術中所見大緻相符.30例患者實際行膽總管切開取石24例,肝實質切開取石6例,肝部分切除術15例,膽腸吻閤16例.規劃手術方案與實際手術方式符閤率為100.0％(30/30).患者均常規進行膽道鏡探查,其中經膽道鏡取石23例.術中實際切除肝髒體積為(261±148) mL.預切除肝髒體積的平均誤差率為5.4％.術前預切除肝髒體積與術後實際切除肝髒體積呈正相關(r=0.902,P＜0.05).患者手術時間為(121 ±65) min,術中齣血量為(158±78)mL.30例患者術後均未齣現膽汁漏,切口感染髮生率為3.3％(1/30).術後2週至3箇月複查CT或膽道造影,證實結石取儘27例,結石殘留率為10.0％(3/30).結論 三維可視化繫統聯閤纖維膽道鏡在肝膽管結石病治療中具有一定的臨床應用及指導價值.
목적 탐토삼유가시화계통연합섬유담도경재간담관결석병치료중적응용개치.방법 회고성분석2012년1월지2013년1월하문대학부속성공의원수치적30례간담관결석병환자적림상자료.소유환자술전행CT검사,응용IQQA-Liver계통장CT이유도상전환성삼유도상,료해결석적위치급여주위비린관계.재삼유도상상제정예수술방안,측량간장체적、예절제간장체적.술중채용전통방법취석연합사용섬유담도경행담관탐사、충세,담도경하쇄석、취석.술후비교실제수술방안여예수술방안적구별.복사CT계산결석잔류솔,계산실제절제간장체적.실제절제간장체적여술전예절제간장체적적상관성검험채용Pearson등급상관분석.결과 30례환자균성공완성삼유중건,기결과청초지현시결석대소、위치급기여주위혈관、담관적비린관계.기중의행담총관절개취석24례,간실질절개취석6례,간부분절제술15례,담관협착성형+담관공장Roux-en-Y문합술16례.삼유중건측득의행간부분절제술적15례환자간장체적위(1 390±148) mL,예절제간장체적위(275±156)mL.술전삼유가시화중건대담관、결석급중요혈관적해부학평고결과여술중소견대치상부.30례환자실제행담총관절개취석24례,간실질절개취석6례,간부분절제술15례,담장문합16례.규화수술방안여실제수술방식부합솔위100.0％(30/30).환자균상규진행담도경탐사,기중경담도경취석23례.술중실제절제간장체적위(261±148) mL.예절제간장체적적평균오차솔위5.4％.술전예절제간장체적여술후실제절제간장체적정정상관(r=0.902,P＜0.05).환자수술시간위(121 ±65) min,술중출혈량위(158±78)mL.30례환자술후균미출현담즙루,절구감염발생솔위3.3％(1/30).술후2주지3개월복사CT혹담도조영,증실결석취진27례,결석잔류솔위10.0％(3/30).결론 삼유가시화계통연합섬유담도경재간담관결석병치료중구유일정적림상응용급지도개치.
Objective To investigate the clinical value of three-dimensional visualization system combined with choledochofiberscope in the treatment of hepatolithiasis.Methods The clinical data of 30 patients with hepatolithiasis who were admitted to the Chenggong Hospital of Xiamen University from January 2012 to January 2013 were retrospectively analyzed.The preoperative two-dimensional images of computed tomography (CT) was converted to the three-dimensional images by IQQA-Liver system.The location of the stones and their relationship with adjacent organs were learned.The surgical plan was made based on the three-dimensional images,and the liver volume and liver volume planed to be excised were measured.Bile duct exploration,washing,lithotripsy and lithotomy were performed using the traditional method combined with choledochofiberscopy.The rate of residual stones and actual volume of liver resected were calculated.The correlation between the volume of actual liver resected and predicted liver resection volume was analyzed by calculating the Pearson correlation coefficient.Results The three-dimensional reconstruction of the CT data of the 30 patients clearly displayed the size,location of the tumor,as well as its relationship with adjacent blood vessels and bile ducts.Surgical plan was made according to the result of three-dimensional reconstruction,including 24 cases of choledochotomy,15 cases of partial liver resection,and 16 cases of bile duct stricture repairment + cholangioenterostomy.The volume of liver of the 15 patients who were planed to receive partial liver resection was (1 390 ± 148) mL,and the volume of liver planed to be resected was (275 ± 156) mL.Preoperative evaluation of the anatomy of blood vessels,stones and bile ducts based on three-dimensional images was confirmed with operative findings.In actual practice,there were 24 patients received choledochotomy,6 received liver parenchyma cutting,15 received partial liver resection and 16 received cholangioenterostomy.The agreement rate of the surgical plan and the actual practice was 100.0％ (30/30).The actual volume of liver resected was (261 ± 148)mL.The mean error rate of the volume of liver planed to be resected was 5.4％.The predicted liver resection volume was positively correlated with the actual liver resection volume (r =0.902,P ＜ 0.05).Exploration with choledochoscope was routinely performed,including 23 cases of lithotomy through choledochofiberscope.The operation time was (121 ± 65)minutes,and the volume of intraoperative blood loss was (158 ± 78) mL.No bile leakage was detected,and the incidence of incisional infection was 3.3％ (1/30).The results of CT or choledochoscopy showed that the rate of residual stones after surgery was 10.0％ (3/30).Conclusion Three-dimensional visualization system combined with choledochofiberscopy is helpful in the treatment of hepatolithisis.
